Healthcare Provider Details

I. General information

NPI: 1316192966
Provider Name (Legal Business Name): PATRICIA M WOOD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 12/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 KENILWORTH DR SUITE 317
TOWSON MD
21204-2139
US

IV. Provider business mailing address

66 4TH ST
NEW FREEDOM PA
17349-8901
US

V. Phone/Fax

Practice location:
  • Phone: 410-296-4616
  • Fax: 410-337-5068
Mailing address:
  • Phone: 410-296-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR145358
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: