Pat Widenoja FNP

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

078041667 Issued in OR

Legal business name

PAT WIDENOJA FNP

Doing business as

North Lake Clinic

Practice address

87520 Bay Rd
Pob 377
Christmas Valley, OR 97641-0377

Phone

(541) 576-2343

Fax

(541) 576-2869

NPI assigned

Mar 20, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patricia D Widenoja, FNP, DNP

Title

Owner

Phone

(541) 576-2343

Specialties & licenses 1

Addresses

Other names 1

• North Lake Clinic Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1457745101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POB377",
            "address_2": "87520 BAY RD",
            "city": "CHRISTMAS VALLEY",
            "state": "OR",
            "postal_code": "97641",
            "telephone_number": "541-576-2343",
            "fax_number": "541-576-2869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87520 BAY RD",
            "address_2": "POB 377",
            "city": "CHRISTMAS VALLEY",
            "state": "OR",
            "postal_code": "976410377",
            "telephone_number": "541-576-2343",
            "fax_number": "541-576-2869"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAT WIDENOJA FNP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-20",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "WIDENOJA",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-576-2343",
        "authorized_official_credential": "FNP, DNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "078041667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Lake Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Louise Merwin
• Kendra Murphy
• North Lake Clinic LLC (North Lake Clinic)
• North Lake Clinic, LLC
• North Lake County Emergency Medical Service, Inc.
• Holly Vore, QMHP1

• Clinic/Center in Christmas Valley, OR
• Providers in Christmas Valley, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.