Individual
CHARLES R WOODRUFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
111 S 5TH ST, DOUGLAS, WY 82633-2434
(307) 359-8667
Mailing address
111 SOUTH 5TH ST, DOUGLAS, WY 82633
(307) 359-8667
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
23694.0835
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08589
BCBS
—
01
—
119058000
WY MCD
WY
01
—
P00058219
RR MED
—
Enumeration date
11/08/2006
Last updated
12/20/2013
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