Individual
MRS. NEDRA G TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7525 PORTWOOD RD, AZLE, TX 76020-5835
(817) 444-5665
(817) 444-9115
Mailing address
7529 PORTWOOD RD, AZLE, TX 76020
(817) 444-5665
(817) 444-9115
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
28761
TX
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
28761
TX
Other
Enumeration date
04/16/2008
Last updated
04/16/2008
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