Individual
DERICKA CANADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
914 E BROADWAY, LOUISVILLE, KY 40204-1037
(502) 589-8600
(502) 589-8771
Mailing address
101 W MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1423
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/22/2010
Last updated
12/22/2010
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