Individual
AMBER LIEVENS WIDENSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1405 MILL ST, NEW LONDON, WI 54961-2155
(920) 531-2030
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 531-2030
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
63792-21
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417255902
—
WI
Enumeration date
03/07/2011
Last updated
12/04/2024
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