MEDICARE: PATRICIA M WOODY CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	9072	TN

General Provider Information

NPI Number	:	1073598116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA M WOODY CRNA

Provider Business Mailing Address
First Line	:	9974 FARM ROAD 909
Second Line	:
City	:	BOGATA
State	:	TX
Zip	:	75417-5137
Country	:	US
Telephone Number	:	731-693-1203
Fax Number	:

Provider Business Practice Location Address
First Line	:	9974 FARM ROAD 909
Second Line	:
City	:	BOGATA
State	:	TX
Zip	:	75417-5137
Country	:	US
Telephone Number	:	731-693-1203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	01/21/2015

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