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1811529381
IVY TIDWELL PROTHRO
BETHESDA, MD
NPI
1811529381
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner Family
(Licence: MD R241507)
Enumeration Date
2020-02-12
Last Update Date
2020-02-12
Business Address
IVY TIDWELL PROTHRO FNP-BC
4701 SANGAMORE RD STE S207
BETHESDA, MD 20816-2529
Phone number: 202-684-7176
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Mailing Address
IVY TIDWELL PROTHRO FNP-BC
4701 SANGAMORE RD STE S207
BETHESDA, MD 20816-2529
Phone number: 202-684-7167
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