Provider Demographics
NPI:1487627311
Name:WOODS, DENNIS J (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:WOODS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:DENNIS
Other - Middle Name:JAMES
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 6210
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-6210
Mailing Address - Country:US
Mailing Address - Phone:505-609-2258
Mailing Address - Fax:505-609-2259
Practice Address - Street 1:801 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5630
Practice Address - Country:US
Practice Address - Phone:505-609-6161
Practice Address - Fax:505-330-3865
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR42887367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM430044194OtherRR MEDICARE
AZ447103Medicaid
CO97428874Medicaid
UTT0128Medicaid
NM10002374OtherLOVELACE HP
NM201018788OtherPRESBYTERIAN HP
NMNM006487OtherBCBS
NMT4939Medicaid
UTT0128Medicaid