Healthcare Provider Details

I. General information

NPI: 1821225384
Provider Name (Legal Business Name): JENNIFER MARIE WOOD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE KRANZ

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N SAINT FRANCIS ST
WICHITA KS
67214-3821
US

IV. Provider business mailing address

PO BOX 356
WICHITA KS
67201-0356
US

V. Phone/Fax

Practice location:
  • Phone: 800-374-5326
  • Fax:
Mailing address:
  • Phone: 800-374-5326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number556903
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1393982012
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number139607
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: