Provider Demographics
NPI:1265604615
Name:WOODRUFF, STEPHANIE B (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:B
Last Name:WOODRUFF
Suffix:
Gender:F
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:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:494-628-0799
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:6TH AVENUE & SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WEST READIING
Practice Address - State:PA
Practice Address - Zip Code:19611-1428
Practice Address - Country:US
Practice Address - Phone:484-628-8269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN503879L163W00000X
PATP005180V363L00000X
PA080129367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA115708OtherGEISINGER
PA3530936000OtherIBC
PA50076310OtherCAPITAL ADVANTAGE
PA1585280OtherGATEWAY
PA2053881OtherHIGHMARK
PA9123457OtherAETNA
PA9123457OtherAETNA