Individual
IDREAKA MCEWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4212 SLOANE ST APT 104, CARROLLTON, TX 75007-2311
(469) 756-9119
Mailing address
4212 SLOANE ST APT 104, CARROLLTON, TX 75007-2311
(469) 756-9119
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
353526
TX
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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