Provider Demographics
NPI:1730788506
Name:WOODY, TONYA GLYNNETTE
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:GLYNNETTE
Last Name:WOODY
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 1:71 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5942
Mailing Address - Country:US
Mailing Address - Phone:304-843-2306
Mailing Address - Fax:
Practice Address - Street 1:87 SWIERKOS DR
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-4209
Practice Address - Country:US
Practice Address - Phone:304-843-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1821206228Medicaid
WV1255523494Medicaid
WV1356607394Medicaid