Provider Demographics
NPI:1346067055
Name:WIEDENMAN, LADONNA (BS)
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:
Last Name:WIEDENMAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 PARKCENTRE WAY STE 7
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1748
Mailing Address - Country:US
Mailing Address - Phone:208-442-7791
Mailing Address - Fax:208-442-7792
Practice Address - Street 1:915 PARKCENTRE WAY STE 7
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1748
Practice Address - Country:US
Practice Address - Phone:208-442-7791
Practice Address - Fax:208-442-7792
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID14776855502084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry