Provider Demographics
NPI:1639490329
Name:WOODGEARD, JAMES FREDRICK JR (LPN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:FREDRICK
Last Name:WOODGEARD
Suffix:JR
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 1:4367 JONATHAN DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1626
Mailing Address - Country:US
Mailing Address - Phone:937-298-3339
Mailing Address - Fax:
Practice Address - Street 1:4367 JONATHAN DR
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-1626
Practice Address - Country:US
Practice Address - Phone:937-298-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN139984-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse