Individual
MEREDYTH LYNN PRADERVAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
228 NE WILSHIRE BLVD, SUITE C, BURLESON, TX 76028-4126
(817) 295-4400
Mailing address
228 NE WILSHIRE BLVD, SUITE C, BURLESON, TX 76028-4126
(817) 295-4400
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT042023
TX
Other
Enumeration date
02/11/2007
Last updated
07/08/2007
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