Individual
DI'ARA WOODS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3 CLUB CENTRE CT STE B1, EDWARDSVILLE, IL 62025-3519
(618) 699-4402
Mailing address
403 GLEN CARBON RD, GLEN CARBON, IL 62034-2965
(314) 749-8906
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
RR MEDICARE
MO
05
—
PENDING
—
MO
Enumeration date
03/03/2016
Last updated
04/24/2023
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