Provider Demographics
NPI:1083610547
Name:WIDENER, ROSE DAWN (NP-C)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:DAWN
Last Name:WIDENER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 RHETT DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5904
Mailing Address - Country:US
Mailing Address - Phone:615-516-3840
Mailing Address - Fax:
Practice Address - Street 1:7105 RAMSEY WAY
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1586
Practice Address - Country:US
Practice Address - Phone:615-446-4999
Practice Address - Fax:615-326-0099
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily