Provider Demographics
NPI:1952383010
Name:WOODS, BONNIE A (CRNA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:A
Last Name:WOODS
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 5208
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5208
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:605 S ARCHUSA AVE
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-2331
Practice Address - Country:US
Practice Address - Phone:601-776-6925
Practice Address - Fax:601-776-7141
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR101430367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126219Medicaid
430076088OtherRAILROAD MEDICARE
430076088OtherRAILROAD MEDICARE
430001534Medicare ID - Type Unspecified