Individual
LAUREN ELIZABETH TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
500 J CLYDE MORRIS BOULEVARD, NEWPORT NEWS, VA 23601-1929
(757) 594-2000
(757) 595-2001
Mailing address
804 SCOTT NIXON MEMORIAL DRIVE, AUGUSTA, GA 30907-2464
(706) 650-0705
(706) 650-1034
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0001237315
VA
Other
Enumeration date
08/10/2012
Last updated
08/10/2012
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