Healthcare Provider Details

I. General information

NPI: 1609171396
Provider Name (Legal Business Name): VONDA LANE CASTANEDA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. VONDA LANE FINKE

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

R3 WOUND CARE & HYPERBARICS 4150 N COLLINS ST
ARLINGTON TX
76005
US

IV. Provider business mailing address

7120 OLDHAM PL
NORTH RICHLAND HILLS TX
76182-5019
US

V. Phone/Fax

Practice location:
  • Phone: 817-337-6604
  • Fax:
Mailing address:
  • Phone: 979-820-2207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA07169
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: