Doctor Name: | LADESSEA MORNAE WOODBERRY |
NPI Number: | 1457715070 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 190 Civic Cir Ste 210 Suite 210 Lewisville, TX - 750673635 |
Business Phone Number: | 9722191200 |
Business Fax Number: | |
Mailing Address: | 210 E Wintergreen Rd, Apt 3204 DESOTO |
State: | TX |
Postal Code: | 751152496 |
Phone Number: | 4696525125 |
Fax Number: | |
NPI Enumeration Date: | 04/09/2016 |
NPI Last Update Date: | 05/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |