Widemark, Erich A

Widemark, Erich A is an individual health care provider with primary practice located at 14415 W Mcdowell Rd Goodyear, Goodyear AZ 85395-2521. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Widemark, Erich A can be contacted via phone (623) 512-4190.

Contact Information

Primary practice address
14415 W Mcdowell Rd Goodyear Goodyear AZ 85395-2521
Phone: (623) 512-4190
Fax: (623) 512-4194
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 083736 Arizona

Profile Details

NPI number 1669468260
LBN Legal business name Widemark, Erich A
Credentials PHD, FNP-BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2005
Last updated Nov 19th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669468260 NPPES
Arizona MEDICAID 630344
Arizona MEDICAID 630344001

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