Provider Demographics
NPI:1194467159
Name:WOOLDRIDGE, DJ SOUTHPAW (RN)
Entity Type:Individual
Prefix:
First Name:DJ
Middle Name:SOUTHPAW
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:PO BOX 35172
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176-5172
Mailing Address - Country:US
Mailing Address - Phone:775-200-9892
Mailing Address - Fax:
Practice Address - Street 1:1060 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1650
Practice Address - Country:US
Practice Address - Phone:505-216-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN67406163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse