Healthcare Provider Details

I. General information

NPI: 1083910269
Provider Name (Legal Business Name): PAULA R WOOD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA R SIMMONS CRNA

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

IV. Provider business mailing address

5336 STADIUM TRACE PKWY STE 104
HOOVER AL
35244-4581
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-7143
  • Fax: 205-939-2505
Mailing address:
  • Phone: 205-795-3411
  • Fax: 855-647-9621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-109487
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: