Provider Demographics
NPI:1720501620
Name:WOODWARD, CAROL (APRN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 400 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1916
Mailing Address - Country:US
Mailing Address - Phone:801-428-4257
Mailing Address - Fax:702-405-3017
Practice Address - Street 1:117 W 400 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1916
Practice Address - Country:US
Practice Address - Phone:801-428-4257
Practice Address - Fax:702-405-3017
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112229628-4405363L00000X
NVAPRN002587363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002587OtherADVANCED PRACTICE CERTIFICATE (APRN)
NVMW4443191OtherDEA CERTIFICATE EXPIRES 5/31/2020