Healthcare Provider Details

I. General information

NPI: 1922301928
Provider Name (Legal Business Name): DEREK WOOD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE ALBANY MEDICAL CENTER
ALBANY NY
12208
US

IV. Provider business mailing address

1696 S OLD POST RD
CASTLETON NY
12033-1700
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-4305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number541525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: