| Doctor Name: | EILEEN M WIDRICK |
| NPI Number: | 1083800874 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | PA01554 |
| Business Practice Address: | 327 W Avenue J Robstown, TX - 783802207 |
| Business Phone Number: | 3613879233 |
| Business Fax Number: | 3613878992 |
| Mailing Address: | Po Box 10426, CORPUS CHRISTI |
| State: | TX |
| Postal Code: | 784600426 |
| Phone Number: | 3612416700 |
| Fax Number: | 3612414302 |
| NPI Enumeration Date: | 09/14/2007 |
| NPI Last Update Date: | 09/14/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA01554 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |