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Rebecca Wideman

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

29200 Harper Ave, Saint Clair Shores, MI 48081-1274

PECOS Enrollment

Based on the most recent information from CMS, provider Rebecca Wideman is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1720438401
Provider Type
Individual
Full Name
Wideman, Rebecca
Title
Mrs.
Credential
FNP-C

Gender
Female
Sole Proprietor
No
Enumeration Date
6/14/2016
Last Updated
12/12/2020

Contact Information

Practice Location

29200 Harper Ave, Saint Clair Shores, MI 48081-1274

(586) 777-7577

Unlisted Fax

Mailing Location

29200 Harper Ave, Saint Clair Shores, MI 48081-1274

(586) 777-7577

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 4704270250 Michigan

Rebecca Wideman

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Anderson, Carrie L

Sheoran, Chand

Verran, Marissa

Jewell, Jacob

Downs, Danielle Marie

Hermes, Megan

Imbrunnone, Ashley

Tandarich, Katja N

Kozak, Jennifer L

Beck, Kathleen