Provider Demographics
NPI:1376155028
Name:LIDDELL, ULONDA
Entity type:Individual
Prefix:MRS
First Name:ULONDA
Middle Name:
Last Name:LIDDELL
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 1:1601 WOODYARD RD
Mailing Address - Street 2:
Mailing Address - City:BELZONI
Mailing Address - State:MS
Mailing Address - Zip Code:39038-3885
Mailing Address - Country:US
Mailing Address - Phone:662-207-7494
Mailing Address - Fax:
Practice Address - Street 1:1601 WOODYARD RD
Practice Address - Street 2:
Practice Address - City:BELZONI
Practice Address - State:MS
Practice Address - Zip Code:39038-3885
Practice Address - Country:US
Practice Address - Phone:662-207-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program