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Individual

MANDIKALA IKOTA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
146 CATTLEMANS CREEK RD, NEWARK, TX 76071-4327
(817) 441-3096
Mailing address
146 CATTLEMANS CREEK RD, NEWARK, TX 76071-4327
(817) 441-3096

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
228234
TX

Other

Enumeration date
12/18/2019
Last updated
12/18/2019
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