Healthcare Provider Details

I. General information

NPI: 1467082529
Provider Name (Legal Business Name): JULIE WIDZINSKI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE EILEEN HERBERT

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 S SAGINAW ST
FLINT MI
48507-2677
US

IV. Provider business mailing address

2941 GALWAY BAY DR
METAMORA MI
48455-9624
US

V. Phone/Fax

Practice location:
  • Phone: 810-275-9152
  • Fax:
Mailing address:
  • Phone: 810-357-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704272022
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: