Individual
DOMINIQUE KWAINE IDAHOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5813 LINCOLN MEADOWS CT, 409, FORT WORTH, TX 76112-1451
(817) 986-6999
Mailing address
5813 LINCOLN MEADOWS CT, 409, FORT WORTH, TX 76112-1451
(817) 986-6999
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
08933451
TX
Other
Enumeration date
09/17/2015
Last updated
09/17/2015
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