Individual
MARK BRENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LVN
Contact information
Practice address
181 S BUCKHORN DR, BASTROP, TX 78602-5602
(515) 321-3755
Mailing address
181 S BUCKHORN DR, BASTROP, TX 78602-5602
(515) 321-3755
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
104432
TX
Other
Enumeration date
02/03/2010
Last updated
02/03/2010
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