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Individual
LISA RAE WOODRUFF
Active
Individual
LISA RAE WOODRUFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
4704253495
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
185256
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346510252
—
MI
01
—
1801818752
BCBSM - BRONSON LAKEVIEW BEHAVIORAL MEDICINE
MI
Enumeration date
01/09/2012
Last updated
04/19/2023
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