Basic Information
| Provider Information | |||||||||
| NPI: | 1366522948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOERDEMAN | ||||||||
| FirstName: | LADONNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD LD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1026 A AVE NE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524025036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193697440 | ||||||||
| FaxNumber: | 3193685603 | ||||||||
| Practice Location | |||||||||
| Address1: | 1026 A AVE NE | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524025036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193697440 | ||||||||
| FaxNumber: | 3193685603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 07/30/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 00702 | IA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.