MEDICARE: MS. ROSE DAWN WIDENER NP-C

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
1	363LF0000X	Family Nurse Practitioner	APN0000011005	TN

General Provider Information

NPI Number	:	1083610547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSE DAWN WIDENER NP-C

Provider Business Mailing Address
First Line	:	5105 RHETT DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-5904
Country	:	US
Telephone Number	:	615-516-3840
Fax Number	:

Provider Business Practice Location Address
First Line	:	7105 RAMSEY WAY
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-1586
Country	:	US
Telephone Number	:	615-446-4999
Fax Number	:	615-326-0099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	10/22/2014

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