Widerborg, Katherine Anne
Widerborg, Katherine Anne is an sole proprietor health care provider with primary practice located at 1537 Fort Jesse Rd Suite A, Normal IL 61761. She recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as her primary health care specialty. Widerborg, Katherine Anne can be contacted via phone (309) 808-0122.Contact Information
Primary practice address
1537 Fort Jesse Rd Suite A
Normal IL 61761
Phone: (309) 808-0122
Fax: (309) 808-0552
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 036-068927 | Illinois |
Profile Details
| NPI number | 1588757579 |
|---|---|
| LBN Legal business name | Widerborg, Katherine Anne |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 2nd, 2006 |
| Last updated | Mar 12th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588757579 | NPPES |
| Illinois | MEDICAID | 0360689271 |
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