Healthcare Provider Details

I. General information

NPI: 1487627311
Provider Name (Legal Business Name): DENNIS J WOODS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DENNIS JAMES WOODS CRNA

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W MAPLE ST
FARMINGTON NM
87401-5630
US

IV. Provider business mailing address

PO BOX 6210
FARMINGTON NM
87499-6210
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6161
  • Fax: 505-330-3865
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR42887
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: