Provider Demographics
NPI:1770356735
Name:WOODWARD, VANESSA N
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:N
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 1:112 TARPON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-2609
Mailing Address - Country:US
Mailing Address - Phone:803-504-1890
Mailing Address - Fax:
Practice Address - Street 1:112 TARPON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-2609
Practice Address - Country:US
Practice Address - Phone:803-504-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN