Healthcare Provider Details

I. General information

NPI: 1124487236
Provider Name (Legal Business Name): CONNIE VIDLER RDCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S LOCUST ST STE 200
DENTON TX
76201-6136
US

IV. Provider business mailing address

4816 ASHWORTH CT
ARLINGTON TX
76017-1036
US

V. Phone/Fax

Practice location:
  • Phone: 940-368-0220
  • Fax:
Mailing address:
  • Phone: 817-602-5362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number137975
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: