Individual
NICOLE MARIE WOODWARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
676 N SAINT CLAIR ST STE 650, CHICAGO, IL 60611-2929
(312) 695-4835
(312) 695-3644
Mailing address
676 N SAINT CLAIR ST STE 650, CHICAGO, IL 60611-2929
(312) 695-4835
(312) 695-3644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085010465
IL
363A00000X
Physician Assistant
10003907A
IN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540849
MEDICARE
IN
05
—
300071353
—
IN
Enumeration date
11/30/2022
Last updated
01/13/2026
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