Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 2016013258 | MO |
NPI | 1316210404 |
---|---|
Provider Name | Carrisann Tennessee Woods |
First Address | Springfield, MO 65808-4046 |
Second Address | Branson, MO 65616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2012 |
Last Update Date | 11/06/2018 |