Provider Demographics
NPI:1942036025
Name:WOODFOLK, TERESA LYN
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYN
Last Name:WOODFOLK
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 1:19304 BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2305
Mailing Address - Country:US
Mailing Address - Phone:216-673-1137
Mailing Address - Fax:
Practice Address - Street 1:19304 BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2305
Practice Address - Country:US
Practice Address - Phone:216-673-1137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty