Provider Demographics
NPI:1598385825
Name:ALLDREDGE, MARGORIE EDITH
Entity type:Individual
Prefix:
First Name:MARGORIE
Middle Name:EDITH
Last Name:ALLDREDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 MESQUITE AVE STE P
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6123
Mailing Address - Country:US
Mailing Address - Phone:928-486-3989
Mailing Address - Fax:928-453-2252
Practice Address - Street 1:1940 MESQUITE AVE STE P
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6123
Practice Address - Country:US
Practice Address - Phone:928-486-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20-00041156246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy