Individual
CHARLOTTE IRENE WIDICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ENP
Contact information
Practice address
322 COLEMAN ST, MARLIN, TX 76661-2358
(254) 803-3561
Mailing address
4250 S HIGHWAY 281, BLANCO, TX 78606
(830) 833-0510
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
575896
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117953308
—
TX
Enumeration date
06/04/2006
Last updated
03/26/2008
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