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General NPI Number Information
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NPI Number | 1942179619
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Entity Type | Individual
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Provider Name | FENG WIDERGREN RN
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Gender | Female
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Dates
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Enumeration Date | 11/01/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 2250 SOQUEL AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95062-1402
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Country | US
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Telephone | 830-600-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 45335 VISTA PL
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City | KING CITY
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State | CA
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Zip | 93930-9715
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Country | US
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Telephone | 831-235-5861
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0812X
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Taxonomy Name | Community Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 95281683
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License Number State | CA
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