Individual
TAWANA MOTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1425 PORTER ST, FORT DETRICK, MD 21702-9211
(301) 619-4653
Mailing address
1425 PORTER ST, FORT DETRICK, MD 21702-9211
(301) 619-4653
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
223182
TX
Other
Enumeration date
11/04/2009
Last updated
11/04/2009
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