Provider Demographics
NPI:1972748408
Name:WOODS, DALE SHIRLEY (SPHN)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:SHIRLEY
Last Name:WOODS
Suffix:
Gender:F
Credentials:SPHN
Other - Prefix:
Other - First Name:DALE
Other - Middle Name:SHIRLEY
Other - Last Name:ECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:258 SEELEY RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13470-2308
Mailing Address - Country:US
Mailing Address - Phone:315-429-3486
Mailing Address - Fax:
Practice Address - Street 1:2714 STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-4041
Practice Address - Country:US
Practice Address - Phone:518-736-5720
Practice Address - Fax:518-762-1382
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-285918163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse