| NPI | 1902498983 |
|---|---|
| Former Name | CYNTHIA DENISE TIDWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 218675) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2021-05-12 |