| NPI | 1255393302 |
|---|---|
| Former Name | MANDIE ALICE TIBBALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX M0585) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: TX M0585) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2018-10-11 |