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Individual
MRS. THRESIAMMA IDICHANDY
Active
Individual
MRS. THRESIAMMA IDICHANDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1207120
TX
363LF0000X
Family Nurse Practitioner
4704171067
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1207120
TEXAS
TX
01
—
4704171067
REGISTERED NNURSE
MI
Enumeration date
08/09/2006
Last updated
10/07/2025
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