STACY WIDEMAN

DORAL, FL
NPI1386243871
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: FL  APRN11012260)
Additional Taxonomies363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: CO  C-RXN.0001379)
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: WA  APRN61166084-NP)
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: GA  RN225736)
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: OR  202104630NP-PP)
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: CA  9501782)
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: TX  1071418)
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: IA  G168450)
Enumeration Date2020-10-26
Last Update Date2023-03-01
Business Address
STACY WIDEMAN
8450 NW 102ND AVE
DORAL, FL 33178-4750
Phone number: 360-643-6562
Mailing Address
STACY WIDEMAN
3235 SATELLITE BLVD STE 300
DULUTH, GA 30096-8688
Phone number: 360-643-6562