Individual
VICKY DIANN WIDEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3020 BAILEY AVE, BUFFALO, NY 14215-2814
(716) 833-3622
(716) 834-4557
Mailing address
3020 BAILEY AVE, BUFFALO, NY 14215-2814
(716) 833-3622
(716) 834-4557
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
101YA0400X
NY
Other
Enumeration date
10/17/2006
Last updated
07/08/2007
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