Provider Demographics
NPI:1821263138
Name:WOODS, RENAE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:LYNN
Last Name:WOODS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 SHAMROCK CIR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1640
Mailing Address - Country:US
Mailing Address - Phone:580-765-1325
Mailing Address - Fax:
Practice Address - Street 1:608 SHAMROCK CIR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1640
Practice Address - Country:US
Practice Address - Phone:580-765-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0073581163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse