Individual
LISA D WIDDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 ROBINSON ST, BINGHAMTON, NY 13904-1735
(607) 773-4460
Mailing address
27 CLARENCE ST, BINGHAMTON, NY 13903-2017
(607) 242-8120
(607) 242-8120
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
660725
NY
Other
Enumeration date
04/21/2025
Last updated
04/21/2025
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