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Individual

LADONNA L IMMKEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6811 AUSTIN CENTER BLVD, SUITE #400, AUSTIN, TX 78731-3146
(512) 628-1840
(512) 628-1840
Mailing address
1301 BARBARA JORDAN BLVD STE 200, AUSTIN, TX 78723-3078
(512) 628-1840
(512) 628-1840

Taxonomy

Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
G4018
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
136490301
TX
05
136490305
TX
Enumeration date
05/16/2006
Last updated
01/10/2012
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