Individual
MARY WIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
407 S MEDICAL ARTS CT STE F, GILLETTE, WY 82716-3372
(307) 688-9255
Mailing address
407 S MEDICAL ARTS CT STE F, GILLETTE, WY 82716-3372
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
511
WY
363A00000X
Physician Assistant
PA53799
CA
Other
Enumeration date
03/10/2011
Last updated
05/24/2021
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