Provider Demographics
NPI:1902216377
Name:WIDELL, HEATHER LYNN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LYNN
Last Name:WIDELL
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:655 7TH ST BLDG 700
Mailing Address - Street 2:78 MDG/SGPF
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2227
Mailing Address - Country:US
Mailing Address - Phone:478-327-7758
Mailing Address - Fax:478-327-7585
Practice Address - Street 1:655 7TH ST BLDG 700
Practice Address - Street 2:78 MDG/SGPF
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-7758
Practice Address - Fax:478-327-7585
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2022-04-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No171000000XOther Service ProvidersMilitary Health Care Provider