| NPI | 1083949911 |
|---|---|
| Former Name | ANDREA SUZETTE WIDEMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: HI AMD-1020) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TX 1090667) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2025-07-30 |