Provider Demographics
NPI:1053348524
Name:WOODS, RICHARD L (CRNA)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:WOODS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 VALLEY STRAN DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8890
Mailing Address - Country:US
Mailing Address - Phone:828-264-6161
Mailing Address - Fax:828-264-6961
Practice Address - Street 1:193 VALLEY STRAN DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-8890
Practice Address - Country:US
Practice Address - Phone:828-264-6161
Practice Address - Fax:828-264-6961
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC078734367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC260196EMedicare ID - Type UnspecifiedMEDICARE ID #