Individual
FAITH BRONAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3911 TREELINE DR, DALLAS, TX 75224-4166
(214) 395-6151
Mailing address
3911 TREELINE DR, DALLAS, TX 75224-4166
(214) 395-6151
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
850651243
—
TX
Enumeration date
08/13/2022
Last updated
08/13/2022
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