Provider Demographics
NPI:1477805414
Name:WIDRICK, JANET A (CD(DONA))
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:A
Last Name:WIDRICK
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PEACH BLOSSOM RD S
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1018
Mailing Address - Country:US
Mailing Address - Phone:585-764-5479
Mailing Address - Fax:
Practice Address - Street 1:24 PEACH BLOSSOM RD S
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1018
Practice Address - Country:US
Practice Address - Phone:585-764-5479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-14
Last Update Date:2012-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula