Individual
MARY ANN WIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1713 S KOFA AVE, SUITE A, PARKER, AZ 85344-6477
(928) 669-9700
(928) 669-9104
Mailing address
1713 S KOFA AVE, SUITE A, PARKER, AZ 85344-6477
(928) 669-9700
(928) 669-9104
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP2864
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00458072
RAILROAD MEDICARE
AZ
Enumeration date
10/09/2007
Last updated
04/15/2015
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