Provider Demographics
NPI:1467082529
Name:WIDZINSKI, JULIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WIDZINSKI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:EILEEN
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2941 GALWAY BAY DR
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9624
Mailing Address - Country:US
Mailing Address - Phone:810-357-1863
Mailing Address - Fax:
Practice Address - Street 1:4800 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2677
Practice Address - Country:US
Practice Address - Phone:810-275-9152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily