Provider Demographics
NPI:1750034997
Name:WOODWARD, LAUREN KRISTINE
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KRISTINE
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 PAMELA ST
Mailing Address - Street 2:APT #6
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5763
Mailing Address - Country:US
Mailing Address - Phone:561-696-2868
Mailing Address - Fax:
Practice Address - Street 1:606 PAMELA ST
Practice Address - Street 2:APT #6
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5763
Practice Address - Country:US
Practice Address - Phone:561-696-2868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist