Provider Demographics
NPI:1861892309
Name:HUGHES-WOODLEY, SAMYRAH
Entity type:Individual
Prefix:MRS
First Name:SAMYRAH
Middle Name:
Last Name:HUGHES-WOODLEY
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 1:514 THAYER ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-3252
Mailing Address - Country:US
Mailing Address - Phone:419-260-2782
Mailing Address - Fax:
Practice Address - Street 1:514 THAYER ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-3252
Practice Address - Country:US
Practice Address - Phone:419-260-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400969020809314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility