Provider Demographics
NPI:1659489219
Name:WOODSON, SUE ALLYSON (CNM)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ALLYSON
Last Name:WOODSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 HYDRAULIC RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8902
Mailing Address - Country:US
Mailing Address - Phone:434-296-1000
Mailing Address - Fax:434-975-3424
Practice Address - Street 1:2964 HYDRAULIC RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8902
Practice Address - Country:US
Practice Address - Phone:434-296-1000
Practice Address - Fax:434-975-3424
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001082072163W00000X
VA0024082072367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA177880OtherANTHEM PROVIDER ID
VA007183C09Medicare ID - Type UnspecifiedMEDICARE