Individual
HEIDI JO EASTRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4503 KENWOOD ST, WICHITA FALLS, TX 76310-2031
(940) 923-4980
Mailing address
4503 KENWOOD ST, WICHITA FALLS, TX 76310-2031
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
211741
TX
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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