Provider Demographics
NPI:1194792424
Name:WOODWARD, CONNIE D (CRNA)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:D
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:W
Other - Last Name:PATERNOSTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3207 CROSSINGS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4471
Mailing Address - Country:US
Mailing Address - Phone:205-980-2124
Mailing Address - Fax:
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-824-4764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATLRN022313367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
037223OtherAANA NO.