Individual
TIRUWORK GUDETA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3519 SWINTON CT, MISSOURI CITY, TX 77459-4809
(240) 462-4919
Mailing address
3519 SWINTON CT, MISSOURI CITY, TX 77459-4809
(240) 462-4919
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
AP129676
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19348
RX.AUTH.NUMBER
TX
Enumeration date
08/16/2018
Last updated
08/16/2018
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