Provider Demographics
NPI:1407806862
Name:WIDZINS, MARYANN CATHRINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARYANN
Middle Name:CATHRINE
Last Name:WIDZINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9212 74TH PL
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8102
Mailing Address - Country:US
Mailing Address - Phone:262-697-8343
Mailing Address - Fax:
Practice Address - Street 1:9212 74TH PL
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8102
Practice Address - Country:US
Practice Address - Phone:262-697-8343
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51824-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIC38202100Medicaid