Healthcare Provider Details

I. General information

NPI: 1972503928
Provider Name (Legal Business Name): CHRISTOPHER WOODWARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 N 8TH ST
ESTHERVILLE IA
51334-1528
US

IV. Provider business mailing address

203 N 8TH ST
ESTHERVILLE IA
51334-1922
US

V. Phone/Fax

Practice location:
  • Phone: 712-362-2631
  • Fax:
Mailing address:
  • Phone: 712-209-3556
  • Fax: 712-362-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number064084
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: