Provider Demographics
NPI:1649761826
Name:WOOLDRIDGE, STEFANI (RD)
Entity type:Individual
Prefix:
First Name:STEFANI
Middle Name:
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4431 HOLLAND AVE APT E
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-5712
Mailing Address - Country:US
Mailing Address - Phone:903-530-4088
Mailing Address - Fax:
Practice Address - Street 1:4431 HOLLAND AVE APT E
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5712
Practice Address - Country:US
Practice Address - Phone:903-530-4088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered