| Doctor Name: | MRS. NEDRA G TIDWELL |
| NPI Number: | 1790959252 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 28761 |
| Business Practice Address: | 7525 Portwood Rd Azle, TX - 760205835 |
| Business Phone Number: | 8174445665 |
| Business Fax Number: | 8174449115 |
| Mailing Address: | 7529 Portwood Rd, AZLE |
| State: | TX |
| Postal Code: | 76020 |
| Phone Number: | 8174445665 |
| Fax Number: | 8174449115 |
| NPI Enumeration Date: | 04/16/2008 |
| NPI Last Update Date: | 04/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 164X00000X |
| License Number: | 28761 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Licensed Vocational Nurse |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. [An alternate term for licensed practical nurse arising from difference in occupational titles between states and post-high school training programs and institutions.] Requirements for education, experience, licensure, and job responsibilities vary among the states. |