SearchTexas225A00000X

Athena Mask, MT-BC

NPI 1952935454 · on the registry since 2020 · sole proprietor

Practice

Address
2455 N Eastman Rd
Longview, TX 75605
Phone
(903) 315-9338

Registry record

Primary taxonomy
225A00000X
225A00000X
Licence states on file
TX
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2020-02-24

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Texas