Provider Demographics
NPI:1730243528
Name:WOOLDRIDGE, GWENNETTA MARIE (RN)
Entity type:Individual
Prefix:
First Name:GWENNETTA
Middle Name:MARIE
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12023 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-3313
Mailing Address - Country:US
Mailing Address - Phone:972-286-1383
Mailing Address - Fax:972-286-1383
Practice Address - Street 1:12023 BISHOP DR
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-3313
Practice Address - Country:US
Practice Address - Phone:972-286-1383
Practice Address - Fax:972-286-1383
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX522090163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse