Individual
LYNN G WIDRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
214 KING ST, OGDENSBURG, NY 13669-1142
(315) 393-3600
Mailing address
214 KING ST, OGDENSBURG, NY 13669-1142
(315) 393-3600
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
490261
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
23000490261
—
NY
Enumeration date
01/12/2007
Last updated
09/19/2013
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