Individual provider · Type 1 NPI

Dericka Canada

Student in an Organized Health Care Education/Training Program · Louisville, KY

NPI number 1104120781 Active

Practice location

914 E Broadway
Louisville, KY 40204-1037

Call (502) 589-8600 Map

Fax (502) 589-8771

Mailing address

101 W Muhammad Ali Blvd
Louisville, KY 40202-1423

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1104120781

Dericka Canada's National Provider Identifier is 1104120781, issued on Dec 22, 2010. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Louisville, KY. The record was last updated on Dec 22, 2010.