Provider Demographics
NPI:1003150616
Name:WOODARD, EVELEAN DAVIS
Entity type:Individual
Prefix:MRS
First Name:EVELEAN
Middle Name:DAVIS
Last Name:WOODARD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:EVELEAN
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 AKINS LN
Mailing Address - Street 2:
Mailing Address - City:MANSON
Mailing Address - State:NC
Mailing Address - Zip Code:27553-9124
Mailing Address - Country:US
Mailing Address - Phone:252-456-2128
Mailing Address - Fax:
Practice Address - Street 1:112 AKINS LN
Practice Address - Street 2:
Practice Address - City:MANSON
Practice Address - State:NC
Practice Address - Zip Code:27553-9124
Practice Address - Country:US
Practice Address - Phone:252-456-2128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-093-040171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor