Most Relevant Information
Provider Data
| NPI Number: | 1003454570 |
| Provider Name: | BRITTANY WIDEBROOK PN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 2019037646 |
Most Important Dates
| Enumeration Date: | 12/16/2019 |
| Last Updated: | 12/16/2019 |
Provider Practice Location
141 COMMUNICATION DR
HANNIBAL
MO
634013670
Practice Location Phone/Fax
| Phone: | 5736031460 |
| Fax: | 5736031462 |
Provider Mailing Location
118 N 2ND ST STE 200
SAINT CHARLES
MO
633012894
Provider Mailing Phone/Fax
| Phone: | 6362241210 |
| Fax: | 6369460991 |