Provider Demographics
NPI:1639252224
Name:WOODS, RENEE BANNING
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:BANNING
Last Name:WOODS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4702 SUMMITVIEW AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-6001
Mailing Address - Country:US
Mailing Address - Phone:509-571-1300
Mailing Address - Fax:877-334-1891
Practice Address - Street 1:4702 SUMMITVIEW AVE STE 102
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-571-1300
Practice Address - Fax:877-334-1891
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0038313208D00000X
WAMD00038313207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4138415OtherAETNA
WA1034867Medicaid
WA8080WOOtherASURIS
WA1034867Medicaid
WAG8859185Medicare ID - Type Unspecified
WA4138415OtherAETNA