Provider Demographics
NPI:1437652021
Name:SIDES, VIOLA MAE
Entity Type:Individual
Prefix:
First Name:VIOLA
Middle Name:MAE
Last Name:SIDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:OK
Mailing Address - Zip Code:74733
Mailing Address - Country:US
Mailing Address - Phone:580-319-4585
Mailing Address - Fax:
Practice Address - Street 1:1919 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75021-7530
Practice Address - Country:US
Practice Address - Phone:903-821-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72708164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse