Doctor Name: | WYATT D WOODARD |
NPI Number: | 1013911916 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSN, FNP |
License Number: | AP1235 |
Business Practice Address: | 320 N Leroux St Ste B Flagstaff, AZ - 860014535 |
Business Phone Number: | 9287790361 |
Business Fax Number: | 9287797143 |
Mailing Address: | 320 N Leroux St, Ste B FLAGSTAFF |
State: | AZ |
Postal Code: | 860014535 |
Phone Number: | 9287790361 |
Fax Number: | 9287797143 |
NPI Enumeration Date: | 06/08/2005 |
NPI Last Update Date: | 06/08/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | AP1235 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |