Organization
RENEW WEIGHT LOSS MARKETING LLC
Active
Other names
Renew DFW
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW THOMAS LITTLE (MANAGER)
(936) 577-4606
Entity
Organization
Contact information
Practice address
6344 CAMP BOWIE BLVD, FORT WORTH, TX 76116-5408
(817) 409-6265
Mailing address
6344 CAMP BOWIE BLVD, FORT WORTH, TX 76116-5408
(817) 409-6265
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174117683
FAMILY PRACTICE
TX
Enumeration date
01/30/2022
Last updated
01/30/2022
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