Healthcare Provider Details

I. General information

NPI: 1952383010
Provider Name (Legal Business Name): BONNIE A. WOODS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S ARCHUSA AVE
QUITMAN MS
39355-2331
US

IV. Provider business mailing address

PO BOX 5208
MERIDIAN MS
39302-5208
US

V. Phone/Fax

Practice location:
  • Phone: 601-776-6925
  • Fax: 601-776-7141
Mailing address:
  • Phone: 601-703-4282
  • Fax: 601-703-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR101430
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: