Basic Information
| Provider Information | |||||||||
| NPI: | 1821449521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOODHOUSE | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | R. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 W CENTRAL PARK AVE | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528041844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634214409 | ||||||||
| FaxNumber: | 5634214449 | ||||||||
| Practice Location | |||||||||
| Address1: | 312 E MAIN ST STE 1000 | ||||||||
| Address2: | |||||||||
| City: | MARSHALLTOWN | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501581992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6417525469 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2016 | ||||||||
| LastUpdateDate: | 10/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 45235 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R-10692 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.