Provider Demographics
NPI:1043645211
Name:WOODRUFF, DAX (LPN)
Entity type:Individual
Prefix:MR
First Name:DAX
Middle Name:
Last Name:WOODRUFF
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43211-1523
Mailing Address - Country:US
Mailing Address - Phone:614-373-5885
Mailing Address - Fax:
Practice Address - Street 1:1563 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43211-1523
Practice Address - Country:US
Practice Address - Phone:614-373-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.130332-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse