Individual
OLIVIA I EWENI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16722 SHADYRIDGE DR, TYLER, TX 75703-7841
(903) 312-7601
Mailing address
16722 SHADYRIDGE DR, TYLER, TX 75703-7841
(903) 312-7601
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/14/2020
Last updated
07/14/2020
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