Active NPI
Amber J Widstrom, PA
- Physician Assistant
- Omaha, NE
National Provider Identifier
1114978368
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1098
- Practice address
- 988095 Nebraska Medical Ctr
Omaha, NE 68198-8095 - Phone
- (402) 559-9800
- Fax
- (402) 559-9840
- NPI assigned
- May 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1098 | NE | Primary |
Addresses
Primary practice location
988095 Nebraska Medical Ctr
Omaha, NE 68198-8095
Mailing address
11033 Crown Point Ave
Omaha, NE 68164-1507
Phone (402) 496-6559
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1098 | NE | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225929600000",
"number": "1114978368",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11033 CROWN POINT AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681641507",
"telephone_number": "402-496-6559",
"fax_number": "402-933-6501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "988095 NEBRASKA MEDICAL CTR",
"city": "OMAHA",
"state": "NE",
"postal_code": "681988095",
"telephone_number": "402-559-9800",
"fax_number": "402-559-9840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDSTROM",
"first_name": "AMBER",
"middle_name": "J",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-12",
"last_updated": "2008-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "1098",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.