Provider Demographics
NPI:1124385455
Name:WIDMER, NANCY (CST)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WIDMER
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7309 N KNOXVILLE AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2086
Mailing Address - Country:US
Mailing Address - Phone:309-692-9210
Mailing Address - Fax:
Practice Address - Street 1:7309 N KNOXVILLE AVE STE 2
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2086
Practice Address - Country:US
Practice Address - Phone:309-692-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other