Healthcare Provider Details

I. General information

NPI: 1205250503
Provider Name (Legal Business Name): AMY RENEE WOOD I CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 3RD ST S
GLASGOW MT
59230-2604
US

IV. Provider business mailing address

320 ALPENGLOW LN
LIVINGSTON MT
59047-8506
US

V. Phone/Fax

Practice location:
  • Phone: 406-228-3500
  • Fax: 406-228-3680
Mailing address:
  • Phone: 406-222-3541
  • Fax: 406-823-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number31354
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: