| NPI | 1053939215 |
|---|---|
| Former Name | KATIE ROCHELLE WIDICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 29659) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000177266) |
| Enumeration Date | 2020-07-13 |
| Last Update Date | 2021-07-22 |