Individual
DIANNA M MADDOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1314 LAKE ST, FORT WORTH, TX 76102-4581
(817) 810-0660
Mailing address
241 SHANKLE AVE, ALVORD, TX 76225-5611
(817) 769-0441
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
338978
TX
Other
Enumeration date
03/17/2021
Last updated
03/17/2021
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