Provider Demographics
NPI:1811185275
Name:WIDMYER, JANET MAY
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MAY
Last Name:WIDMYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 TONGASS AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5742
Mailing Address - Country:US
Mailing Address - Phone:907-228-4902
Mailing Address - Fax:907-228-5256
Practice Address - Street 1:2960 TONGASS AVEUNE
Practice Address - Street 2:SUITE 403
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-228-4902
Practice Address - Fax:907-228-5256
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24429163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK24429OtherSTATE LICENSE