ERICH A WIDEMARK (NPI# 1669468260) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669468260 |
| Entity Type | Individual |
| Full Name | ERICH A WIDEMARK |
| Credential | PHD, FNP-BC |
| Practice Address |
14415 W Mcdowell Rd Goodyear Goodyear AZ 85395-2521 |
| Mailing Address |
14415 W Mcdowell Rd Suite D2 Goodyear AZ 85395-2521 |
| Practice Telephone | 6235124190 |
| Practice Fax Number | 6235124194 |
| Mailing Telephone | 6235124190 |
| Mailing Fax Number | 6235124194 |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2009-11-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
083736 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 630344001 | 05 | |
| AZ | 630344 | 05 |
| Street Address |
14415 W MCDOWELL RD GOODYEAR |
| City | GOODYEAR |
| State | AZ |
| Zip Code | 85395-2521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992702203 | Navtej S. Tung | Anesthesiology | 14415 W Mcdowell Rd, Suite D102, Goodyear, AZ 85395-2521 | 2005-06-30 |
| 1285849372 | Prineet K Tung | Internal Medicine | 14415 W Mcdowell Rd, Suite D102, Goodyear, AZ 85395-2521 | 2007-05-11 |
| 1831126044 | Ann M Voght | Physician Assistant | 14415 W Mcdowell Rd, Suite D102, Goodyear, AZ 85395-2521 | 2006-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154962439 | Amber Dawn Gutierrez | Registered Nurse | 15430 W. Turney Avenue, Goodyear, AZ 85395 | 2019-10-08 |
| 1851947865 | Az Care Partners Home Care, LLC | Chore Provider | 14122 W. Mcdowell Rd., Suite 102a, Goodyear, AZ 85395 | 2019-08-15 |
| 1407334329 | Hana M Eichele | Occupational Therapist | 13385 W Mcdowell Road, Goodyear, AZ 85395 | 2018-08-02 |
| 1639662406 | Kristen Henderson | Occupational Therapist | 14577 W Indian School Road, Goodyear, AZ 85395 | 2018-06-07 |
| 1114419389 | Eric Seabaugh | Specialist/Technologist | 13385 W. Mcdowell Rd., Goodyear, AZ 85395 | 2018-06-04 |
| 1912497504 | Goodyear Modern Dentistry, LLP | Dentist | 15260 West Mcdowell Rd, Goodyear, AZ 85395 | 2018-05-18 |
| 1225531551 | Erik Jason Martinez | Registered Nurse | 4565 N 153rd Ln, Goodyear, AZ 85395 | 2018-03-13 |
| 1538677042 | Kacie Bartlett | Speech-Language Pathologist | 14557 W Mcdowel Rd, Suiet 500, Goodyear, AZ 85395 | 2018-01-18 |
| 1942717277 | Deeann Guymon | Specialist/Technologist | 13385 W. Mcdowell Road, Goodyear, AZ 85395 | 2018-01-09 |
| 1023520228 | Kathy Lynn Gorchesky | Registered Nurse | 15430 West Turney Avenue, Goodyear, AZ 85395 | 2017-10-27 |
| Find all providers in zip 85395 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912543067 | Cristina Norman | Nurse Practitioner | 16081 W Papago St, Goodyear, AZ 85338-7908 | 2019-11-25 |
| 1184286809 | Jana Hollyann White | Nurse Practitioner | 18666 W Mcneil St, Goodyear, AZ 85338-4910 | 2019-07-02 |
| 1962960187 | Kelly Lynn Zabierek | Nurse Practitioner | 15046 W Coolidge St, Goodyear, AZ 85395-7712 | 2019-03-06 |
| 1457817306 | Danielle Placencia Tafoya | Nurse Practitioner | 1325 N Litchfield Rd Ste 120, Goodyear, AZ 85395-1214 | 2019-02-15 |
| 1184123788 | Jennifer Garcia Rodriguez | Nurse Practitioner | 15749 W Vernon Ave, Goodyear, AZ 85395-7534 | 2018-02-08 |
| 1790206159 | James Stangle | Nurse Practitioner | 3050 N Litchfield Rd Ste 130, Goodyear, AZ 85395-7806 | 2017-07-06 |
| 1740730944 | Rebecca Valdez Kirkley | Nurse Practitioner | 16798 W Hammond St, Goodyear, AZ 85338-7438 | 2016-10-12 |
| 1851741607 | Milvia Nwunfor Suh Fominyam | Nurse Practitioner | 16778 W Apache St, Goodyear, AZ 85338-7433 | 2016-06-13 |
| 1447605639 | Tracy Von Aspen | Nurse Practitioner | 1325 N Litchfield Rd # 125, Goodyear, AZ 85395-1228 | 2016-04-26 |
| 1255700506 | Jane-frances Ndemanu | Nurse Practitioner | 18168 W Wind Song Ave, Goodyear, AZ 85338-5063 | 2015-09-16 |
| Find all providers in GOODYEAR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.