Provider Demographics
NPI:1417522376
Name:HUNTER-RADFORD, DORETHEA LASHUN
Entity Type:Individual
Prefix:
First Name:DORETHEA
Middle Name:LASHUN
Last Name:HUNTER-RADFORD
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:PO BOX 1324
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1324
Mailing Address - Country:US
Mailing Address - Phone:469-772-0428
Mailing Address - Fax:
Practice Address - Street 1:3118 STONEHENGE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4064
Practice Address - Country:US
Practice Address - Phone:469-772-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1051603163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty