Individual
BAM LEACH-WONGSAPROME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3883 MIGHTY MITE DRIVE, FORT WORTH, TX 76119
(817) 335-3022
Mailing address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 569-4300
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
841712
TX
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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