Basic Information
| Provider Information | |||||||||
| NPI: | 1336219831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2301 SPITFIRE WAY | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958344027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034751966 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 726 4TH ST | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959015656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307407928 | ||||||||
| FaxNumber: | 5307514906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 200642513RN | OR | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 367500000X | 95146735 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.