Doctor Name: | BRENDA WODARSKI |
NPI Number: | 1043640337 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | AS700317377 |
Business Practice Address: | 3109 S Bluff Ct Hudsonville, MI - 494261580 |
Business Phone Number: | 6162095029 |
Business Fax Number: | |
Mailing Address: | 3761 Bradwood Ct Nw, WALKER |
State: | MI |
Postal Code: | 495342722 |
Phone Number: | 6165403038 |
Fax Number: | |
NPI Enumeration Date: | 11/22/2013 |
NPI Last Update Date: | 11/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 376G00000X |
License Number: | AS700317377 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Nursing Service Related Providers |
Taxonomy Classification: | Nursing Home Administrator |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual, often licensed by the state, who is responsible for the management of a nursing home. |