Healthcare Provider Details

I. General information

NPI: 1629046917
Provider Name (Legal Business Name): DAVID A WOOD JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974A SAXONBURG BLVD
SAXONBURG PA
16056-2318
US

IV. Provider business mailing address

974A SAXONBURG BLVD
SAXONBURG PA
16056-2318
US

V. Phone/Fax

Practice location:
  • Phone: 724-265-4065
  • Fax: 724-265-4056
Mailing address:
  • Phone: 724-265-4065
  • Fax: 724-265-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN298327L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: