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Individual
TONYA L TIDWELL
Active
Individual
TONYA L TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041316348
IL
363LF0000X
Family Nurse Practitioner
Primary
209016801
IL
Other
Enumeration date
09/28/2017
Last updated
03/16/2021
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