Individual
MS. PHYLLIS M WOODSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
855 W BRAMBLETON AVE, NORFOLK, VA 23510-1005
(757) 446-5908
(757) 446-7055
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 446-5908
(757) 446-7055
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
R37612-2
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-033
TRICARE/CHAMPUS
VA
05
—
1790753382
—
VA
01
—
2116995
UHC/MAMSI
VA
01
—
PAR
VIRGINIA PREMIER HEALTH
VA
Enumeration date
03/09/2006
Last updated
08/05/2010
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