Individual
TANYA KIDANDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1325 PENNSYLVANIA AVE STE 560, FORT WORTH, TX 76104-2152
(817) 250-7240
Mailing address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
6586-33
WI
363LP2300X
Primary Care Nurse Practitioner
Primary
1030527
TX
Other
Enumeration date
09/10/2015
Last updated
10/09/2024
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