Basic Information
| Provider Information | |||||||||
| NPI: | 1780084780 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODBURN | ||||||||
| FirstName: | GEORJANE | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 848268 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752848268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034161726 | ||||||||
| FaxNumber: | 9034161701 | ||||||||
| Practice Location | |||||||||
| Address1: | 814 MARTIN RD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791076814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063517600 | ||||||||
| FaxNumber: | 8063424789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2014 | ||||||||
| LastUpdateDate: | 03/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP125840 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | AP125840 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.