Individual
CHARLES VINCENT WOODSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2920 MCINTIRE DRIVE, SUITE 150, ATTN: MARIA MITCHELL, BLOOMINGTON, IN 47403
(812) 337-5003
(812) 337-5010
Mailing address
PO BOX 5635, ATTN: MARIA MITCHELL, BLOOMINGTON, IN 47407
(812) 337-5003
(812) 337-5010
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28126400A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000386593
SIA-ANTHEM
IN
Enumeration date
05/31/2006
Last updated
12/17/2007
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