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General NPI Number Information
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NPI Number | 1639155286
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Entity Type | Individual
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Provider Name | CARMELLA LOUISE D'ADDEZIO D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2005
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 149 HART ST 82 MDG/SGOP
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City | SHEPPARD AFB
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State | TX
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Zip | 76311-3478
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Country | US
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Telephone | 940-676-4472
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Fax | 950-676-8005
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Provider Business Mailing Address
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Address Line | 149 HART STREET INTERNAL MEDICINE CLINIC
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City | WICHITA FALLS
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State | TX
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Zip | 76311-3478
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Country | US
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Telephone | 940-676-4472
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Fax | 940-676-8005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 5101007141
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License Number State | MI
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