Individual
SAMUEL LAWRENCE WIDDOWSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-BC
Contact information
Practice address
3676 PARKER BLVD, PUEBLO, CO 81008-2212
(484) 619-1973
Mailing address
3676 PARKER BLVD, PUEBLO, CO 81008-2212
(484) 619-1973
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN.0991213-NP
CO
363LF0000X
Family Nurse Practitioner
SP013311
PA
Other
Enumeration date
11/06/2013
Last updated
09/20/2016
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