Basic Information
Provider Information
NPI: 1003145053
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WOOD
FirstName: ANGELA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BURGESS
OtherFirstName: ANGELA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 300 MAIN ST
Address2: CENTRAL MAINE MEDICAL CENTER
City: LEWISTON
State: ME
PostalCode: 042407027
CountryCode: US
TelephoneNumber: 2077950111
FaxNumber:  
Practice Location
Address1: 300 MAIN ST
Address2: CENTRAL MAINE MEDICAL CENTER
City: LEWISTON
State: ME
PostalCode: 042407027
CountryCode: US
TelephoneNumber: 2077950111
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/21/2009
LastUpdateDate: 12/21/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XAA093042MEY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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