Provider Demographics
NPI:1326040833
Name:WOOD, DONALD WILLACE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:WILLACE
Last Name:WOOD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3110 S VICTOR AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2228
Mailing Address - Country:US
Mailing Address - Phone:918-742-1884
Mailing Address - Fax:918-742-6674
Practice Address - Street 1:3110 S VICTOR AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2228
Practice Address - Country:US
Practice Address - Phone:918-742-1884
Practice Address - Fax:918-742-6674
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0035409367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered