Basic Information
Provider Information
NPI: 1033558267
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOODARD
FirstName: LIBBY
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1715 DOUSMAN ST
Address2:  
City: GREEN BAY
State: WI
PostalCode: 543033211
CountryCode: US
TelephoneNumber: 9204964700
FaxNumber: 9204964705
Practice Location
Address1: 1715 DOUSMAN ST
Address2:  
City: GREEN BAY
State: WI
PostalCode: 543033211
CountryCode: US
TelephoneNumber: 9204964700
FaxNumber: 9204964705
Other Information
ProviderEnumerationDate: 06/20/2013
LastUpdateDate: 09/10/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X197213-30WIN Nursing Service ProvidersRegistered Nurse 
363L00000X5380-33WIN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
367A00000X14882-32WIY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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