Doctor Name: | NATHAN CHASE WIDENER |
NPI Number: | 1508142514 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 102 E Broadway St Anadarko, OK - 730052824 |
Business Phone Number: | 4052475437 |
Business Fax Number: | 4052479778 |
Mailing Address: | 102 E Broadway St, ANADARKO |
State: | OK |
Postal Code: | 730052824 |
Phone Number: | 4052475437 |
Fax Number: | 4052479778 |
NPI Enumeration Date: | 10/24/2011 |
NPI Last Update Date: | 10/24/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |