| NPI | 1154638526 |
|---|---|
| Former Name | REBECCA RUTH TIDRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2317) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704244300) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704244300) | |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2019-06-11 |