Individual
TYDESHEAIA LADEJENEE POOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 CEDAR BRANCH DR, WYLIE, TX 75098-6678
(601) 810-4101
Mailing address
2996 WESTVISTA CIR APT 2996, FORT WORTH, TX 76133-5792
(601) 810-4101
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
08/16/2019
Last updated
11/07/2019
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