Doctor Name: | TOMMIE VIDALES |
NPI Number: | 1598964173 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 642208 |
Business Practice Address: | 103 John Dupree Dr Levelland, TX - 793366326 |
Business Phone Number: | 8068942465 |
Business Fax Number: | 8068948897 |
Mailing Address: | 1804 College Ave, LEVELLAND |
State: | TX |
Postal Code: | 793366507 |
Phone Number: | 8068943141 |
Fax Number: | 8068947094 |
NPI Enumeration Date: | 07/13/2007 |
NPI Last Update Date: | 07/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 642208 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |