Individual
EDDIE DEMICHAEL WADDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16707 SONATA CT, HOUSTON, TX 77053-5023
(832) 880-4629
Mailing address
1243 MAGNOLIA DALE DR, FRESNO, TX 77545-9681
(832) 880-4629
(281) 972-9544
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01134881
—
TX
Enumeration date
06/24/2019
Last updated
06/24/2019
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