Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | TX |
NPI | 1073123543 |
---|---|
Provider Name | Connie Lavonne Reid |
First Address | Glenn Heights, TX 75154-3862 |
Second Address | Glenn Heights, TX 75154-3862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2020 |
Last Update Date | 08/08/2020 |