Provider Demographics
NPI:1760978407
Name:EHRET, LINDA WIDMAR (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:WIDMAR
Last Name:EHRET
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 1:2727 S KEMP RD
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:WI
Mailing Address - Zip Code:53505-9524
Mailing Address - Country:US
Mailing Address - Phone:608-290-6300
Mailing Address - Fax:608-676-4460
Practice Address - Street 1:2727 S KEMP RD
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:WI
Practice Address - Zip Code:53505-9524
Practice Address - Country:US
Practice Address - Phone:608-290-6300
Practice Address - Fax:608-676-4460
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI89448163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health