1215900170 NPI number — MRS. MARY LOUISE WOOLDRIDGE MSN, APRN, BC

Table of content: MRS. MARY LOUISE WOOLDRIDGE MSN, APRN, BC (NPI 1215900170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215900170 NPI number — MRS. MARY LOUISE WOOLDRIDGE MSN, APRN, BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOLDRIDGE
Provider First Name:
MARY
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN, BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215900170
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WILFORD HALL MEDICAL CENTER ATTN: CREDENTIALS (CMC)
Provider Second Line Business Mailing Address:
2200 BERGQUIST DRIVE SUITE 1
Provider Business Mailing Address City Name:
LACKLAND AFB
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78236-5300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-925-5341
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 AEROSPACE MEDICINE SQUADRON
Provider Second Line Business Practice Location Address:
203 GALAXY RD SUITE 106
Provider Business Practice Location Address City Name:
LACKLAND AIR FORCE BASE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78236-0112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-925-5341
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)