Provider Demographics
NPI:1205485133
Name:WIDENER, JOETTE
Entity type:Individual
Prefix:
First Name:JOETTE
Middle Name:
Last Name:WIDENER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 GLENFAIR DR
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5217
Mailing Address - Country:US
Mailing Address - Phone:970-531-6221
Mailing Address - Fax:
Practice Address - Street 1:2141 GLENFAIR DR
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5217
Practice Address - Country:US
Practice Address - Phone:970-531-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider