Basic Information
Provider Information | |||||||||
NPI: | 1235636606 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WOODY | ||||||||
FirstName: | EMILY | ||||||||
MiddleName: | C | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MPH, RDN, IBCLC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CLEAVES | ||||||||
OtherFirstName: | EMILY | ||||||||
OtherMiddleName: | C | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MPH, RDN, IBCLC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 500 25TH PL NE APT 102 | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200025086 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9089179386 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4927 AUBURN AVE STE 100 | ||||||||
Address2: |   | ||||||||
City: | BETHESDA | ||||||||
State: | MD | ||||||||
PostalCode: | 208142641 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3019439293 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/11/2018 | ||||||||
LastUpdateDate: | 04/11/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 1029527 | DC | N |   | Dietary & Nutritional Service Providers | Dietitian, Registered |   | 174N00000X | L-102668 | DC | Y |   | Other Service Providers | Lactation Consultant, Non-RN |   |
No ID Information.