Individual
PATRICIA DIANE WIDENOJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, MN, FNP
Contact information
Practice address
85955 RAVEN RIDGE LN, SILVER LAKE, OR 97638-9627
(541) 576-3070
(541) 576-3070
Mailing address
85955 RAVEN RIDGE LN, SILVER LAKE, OR 97638-9627
(541) 576-3070
(541) 576-3070
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
078041667N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051750
—
OR
01
—
ANP0170
WORKERS COMPENSATION
OR
Enumeration date
11/11/2005
Last updated
03/07/2023
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