Individual
CAROLYN BANCOOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17634 CREEKSIDE DR, LINDALE, TX 75771-6247
(903) 262-5844
Mailing address
755 S BECKHAM AVE, TYLER, TX 75701-1903
(903) 534-4684
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
302347
TX
Other
Enumeration date
02/20/2018
Last updated
02/20/2018
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