Individual
JENNIFER WIDJAJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8035 E BROWN RD, MESA, AZ 85207-3901
(623) 295-1190
Mailing address
9458 E THEIA DR, MESA, AZ 85212-8545
(480) 240-0555
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
317968
AZ
Other
Enumeration date
03/06/2025
Last updated
03/06/2025
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