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NPI Code Detail

MEDICARE: CHARLOTTE IRENE WIDICK ENP

MEDICARE: CHARLOTTE IRENE WIDICK ENP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner575896TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376581751
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLOTTE IRENE WIDICK ENP
Provider Business Mailing Address
First Line : 4250 S HIGHWAY 281
Second Line :
City : BLANCO
State : TX
Zip : 78606
Country : US
Telephone Number : 830-833-0510
Fax Number :
Provider Business Practice Location Address
First Line : 322 COLEMAN ST
Second Line :
City : MARLIN
State : TX
Zip : 76661-2358
Country : US
Telephone Number : 254-803-3561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2006
Last Update Date : 03/26/2008

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Directions to “ CHARLOTTE IRENE WIDICK ENP” Practice Location

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