Individual
LELON DARWIN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RNFA
Contact information
Practice address
11801 SOUTH FWY, BURLESON, TX 76028-7021
(817) 293-9110
Mailing address
PO BOX 11219, FORT WORTH, TX 76110-0219
(817) 294-7444
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
436290
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
436290
RN LICENSE
TX
Enumeration date
05/14/2008
Last updated
05/14/2008
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