Provider Demographics
NPI:1215900170
Name:WOOLDRIDGE, MARY LOUISE (MSN, APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOUISE
Last Name:WOOLDRIDGE
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WILFORD HALL MEDICAL CENTER ATTN: CREDENTIALS (CMC)
Mailing Address - Street 2:2200 BERGQUIST DRIVE SUITE 1
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5300
Mailing Address - Country:US
Mailing Address - Phone:210-925-5341
Mailing Address - Fax:
Practice Address - Street 1:433 AEROSPACE MEDICINE SQUADRON
Practice Address - Street 2:203 GALAXY RD SUITE 106
Practice Address - City:LACKLAND AIR FORCE BASE
Practice Address - State:TX
Practice Address - Zip Code:78236-0112
Practice Address - Country:US
Practice Address - Phone:210-925-5341
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily