1609171396 NPI number — MRS. VONDA LANE CASTANEDA PA

Table of content: MRS. VONDA LANE CASTANEDA PA (NPI 1609171396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609171396 NPI number — MRS. VONDA LANE CASTANEDA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTANEDA
Provider First Name:
VONDA
Provider Middle Name:
LANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FINKE
Provider Other First Name:
VONDA
Provider Other Middle Name:
LANE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609171396
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7120 OLDHAM PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH RICHLAND HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76182-5019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-820-2207
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
R3 WOUND CARE & HYPERBARICS
Provider Second Line Business Practice Location Address:
4150 N COLLINS ST
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-337-6604
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2011

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: 363A00000X , with the licence number:  PA07169 , 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)