Individual
MARKEYTA TRENICE LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 E GLENN ST, LONGVIEW, TX 75602-3436
(903) 746-8939
Mailing address
201 E GLENN ST, LONGVIEW, TX 75602-3436
(903) 746-8939
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
234100
TX
Other
Enumeration date
05/07/2019
Last updated
05/07/2019
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