Provider Demographics
NPI:1699762823
Name:WOODS, NINA J (MED,ED,S)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:J
Last Name:WOODS
Suffix:
Gender:F
Credentials:MED,ED,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3447
Mailing Address - Country:US
Mailing Address - Phone:208-743-6731
Mailing Address - Fax:
Practice Address - Street 1:307 SAINT JOHNS WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2435
Practice Address - Country:US
Practice Address - Phone:208-750-1802
Practice Address - Fax:208-750-1803
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID000059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional