Individual
AMANDA WIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
6700 NE 162ND AVE STE 411, VANCOUVER, WA 98682-3863
(509) 703-8880
Mailing address
PO BOX 236, BAKER CITY, OR 97814-0236
(509) 703-8880
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000021970
—
Other
Enumeration date
07/14/2015
Last updated
07/14/2015
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