Provider Demographics
NPI:1134563083
Name:BOX, LADYJOAN (NP)
Entity type:Individual
Prefix:
First Name:LADYJOAN
Middle Name:
Last Name:BOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21309 FOSTER RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4209
Mailing Address - Country:US
Mailing Address - Phone:281-587-1700
Mailing Address - Fax:281-907-6003
Practice Address - Street 1:21309 FOSTER RD
Practice Address - Street 2:STE 100
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388
Practice Address - Country:US
Practice Address - Phone:281-587-1700
Practice Address - Fax:281-907-6003
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX765352OtherTEXAS BOARD OF NURSING - NURSE PRACTITIONER LICENSE