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Individual

ELIZABETH H. WIDASKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
4200 W MEMORIAL RD STE 410, OKLAHOMA CITY, OK 73120-8305
(405) 608-3866
(405) 607-2976
Mailing address
4200 W MEMORIAL RD STE 410, OKLAHOMA CITY, OK 73120-8305
(405) 608-3866
(405) 607-2976

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
632316
TX
363LA2200X
Adult Health Nurse Practitioner
Primary
91951
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200197740A
OK
Enumeration date
02/21/2007
Last updated
02/24/2017
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