Provider Demographics
NPI:1508142514
Name:WIDENER, NATHAN CHASE
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:CHASE
Last Name:WIDENER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ANADARKO
Mailing Address - State:OK
Mailing Address - Zip Code:73005-2824
Mailing Address - Country:US
Mailing Address - Phone:405-247-5437
Mailing Address - Fax:405-247-9778
Practice Address - Street 1:102 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ANADARKO
Practice Address - State:OK
Practice Address - Zip Code:73005-2824
Practice Address - Country:US
Practice Address - Phone:405-247-5437
Practice Address - Fax:405-247-9778
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)