Provider Demographics
NPI:1932078391
Name:DUTERTE, LADY JANICE CUSTODIO
Entity type:Individual
Prefix:
First Name:LADY JANICE
Middle Name:CUSTODIO
Last Name:DUTERTE
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 1:12777 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1644
Mailing Address - Country:US
Mailing Address - Phone:917-655-3784
Mailing Address - Fax:972-472-8881
Practice Address - Street 1:12777 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-1644
Practice Address - Country:US
Practice Address - Phone:917-655-3784
Practice Address - Fax:972-472-8881
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX783146163WN1003X, 163WW0000X, 163WI0500X, 163WA2000X, 163WC1500X, 163WC0400X, 163WC1600X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health