1497100838 NPI number — AIMEE ELIZABETH WIDNER, M.D., PLLC

Table of content: DEANNE STARR ENDY DO (NPI 1609045228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497100838 NPI number — AIMEE ELIZABETH WIDNER, M.D., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIMEE ELIZABETH WIDNER, M.D., PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497100838
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
746 WILBURN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEBER SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72543-8902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-270-4116
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
746 WILBURN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEBER SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72543-8902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-270-4116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WIDNER
Authorized Official First Name:
AIMEE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
BUSINESS OWNER
Authorized Official Telephone Number:
501-454-3334

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  E9529 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)