Healthcare Provider Details

I. General information

NPI: 1184700197
Provider Name (Legal Business Name): LUCIA BETH WALDROP NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WEST DEAN KEETON
AUSTIN TX
78713-7339
US

IV. Provider business mailing address

3004 QUAIL RUN DR
ROUND ROCK TX
78681-1207
US

V. Phone/Fax

Practice location:
  • Phone: 512-475-8218
  • Fax: 512-232-7552
Mailing address:
  • Phone: 512-246-6196
  • Fax: 512-246-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number223291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: