Individual
DR. MARNIE JEAN WIDDIFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1542 S BLOOMINGTON ST, GREENCASTLE, IN 46135-2297
(765) 301-7617
(765) 301-7621
Mailing address
549 E COUNTY LINE RD, SUITE A, GREENWOOD, IN 46143-1067
(317) 497-6180
(317) 497-6184
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01051575A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000001373
MPLAN (PROHEALTH)
IN
01
—
000000336833
BLUE CROSS / BLUE SHIELD
IN
01
—
510512209
PROHEALTH
IN
01
—
P00201816
RR MEDICARE
IN
Enumeration date
01/31/2006
Last updated
03/31/2021
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