Individual
TAMMIE LUCINDA TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 RED ROCK ST, LAS VEGAS, NV 89146-1232
(702) 406-9304
(702) 367-3445
Mailing address
1700 RED ROCK ST, LAS VEGAS, NV 89146-1232
(702) 406-9304
(702) 367-3445
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
CA
Other
Enumeration date
09/09/2019
Last updated
09/09/2019
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