Individual
LETISHIA LYNE EIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
910 DYER ST, MALVERN, AR 72104-5253
(501) 467-4445
Mailing address
112 SMITH LOOP, MALVERN, AR 72104-2092
(501) 467-4445
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4697
AR
Other
Enumeration date
05/14/2007
Last updated
07/08/2007
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