Individual
WALLETTE GWEN WIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6602 WATERS AVE BLDG C, SAVANNAH, GA 31406-2716
(912) 354-7676
(912) 790-6456
Mailing address
6602 WATERS AVE BLDG C, SAVANNAH, GA 31406-2716
(912) 354-7676
(912) 790-6456
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN113693
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410170417A
—
GA
Enumeration date
08/25/2006
Last updated
08/05/2010
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