Individual provider · Type 1 NPI
Jennifer Widjaja
Gerontology Nurse Practitioner · Mesa, AZ
NPI number
1942008651
Active
Practice location
8035 E Brown Rd
Mesa, AZ 85207-3901
Mailing address
9458 E Theia Dr
Mesa, AZ 85212-8545
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Gerontology Nurse Practitioner Primary | 363LG0600X | 317968 (AZ) |
Gerontology Nurse Practitioner: Definition to come...
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- Megan L. Bruxer, NPGerontology Nurse Practitioner Mesa, AZ NPI 1346987336
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- Ampili Umayamma, NPGerontology Nurse Practitioner Mesa, AZ NPI 1467901769
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About NPI 1942008651
Jennifer Widjaja's National Provider Identifier is 1942008651, issued on Mar 6, 2025. The primary taxonomy on file is Gerontology Nurse Practitioner (363LG0600X), and the practice location is in Mesa, AZ. The record was last updated on Mar 6, 2025.