Individual
MS. AMANDA MAE WIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1816 8TH AVE, OLIVEHURST, CA 95961-4305
(405) 489-2179
Mailing address
1816 8TH AVE, OLIVEHURST, CA 95961-4305
(405) 489-2179
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
CA
101YP2500X
Professional Counselor
—
CA
146N00000X
Basic Emergency Medical Technician
—
CA
171M00000X
Case Manager/Care Coordinator
—
CA
172A00000X
Driver
—
CA
172V00000X
Community Health Worker
Primary
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
116993628
DUNS
CA
05
—
1659838522
—
CA
Enumeration date
02/26/2019
Last updated
04/16/2019
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