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Individual
TIMATHY ALLEN TIDWELL
Active
Individual
TIMATHY ALLEN TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN117180MEDS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RQ790093
OHIO DRIVERS LICENSE
OH
Enumeration date
01/30/2023
Last updated
01/30/2023
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