Individual
CHARLOTTE B VDOVYCHENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2801 BRAZOS BLVD, APT 4309, EULESS, TX 76039-5435
(817) 915-1800
(682) 503-6649
Mailing address
PO BOX 59, EULESS, TX 76039-0059
(817) 915-1800
(682) 503-6649
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
Primary
4075
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1689829418
NPI
—
Enumeration date
11/20/2008
Last updated
02/04/2016
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