Individual
JONTA DELISA TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3026 18TH ST S, FARGO, ND 58103-6716
(480) 286-8603
Mailing address
3026 18TH ST S, FARGO, ND 58103-6716
(480) 286-8603
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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