Provider Demographics
NPI:1790087013
Name:WIDLUND, TRICIA LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:WIDLUND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-0430
Mailing Address - Country:US
Mailing Address - Phone:515-955-9200
Mailing Address - Fax:515-955-9201
Practice Address - Street 1:119 AVENUE O W
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5634
Practice Address - Country:US
Practice Address - Phone:515-955-9200
Practice Address - Fax:515-955-9201
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA093647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily