Amanda Widman, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000021970

Practice address

6700 NE 162ND Ave Ste 411
Vancouver, WA 98682-3863

Phone

(509) 703-8880

NPI assigned

Jul 14, 2015

Last updated

Jul 14, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436832000000",
    "number": "1710361225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 236",
            "city": "BAKER CITY",
            "state": "OR",
            "postal_code": "978140236",
            "telephone_number": "509-703-8880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 NE 162ND AVE STE 411",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823863",
            "telephone_number": "509-703-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDMAN",
        "first_name": "AMANDA",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-14",
        "last_updated": "2015-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": "2000021970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis James Wickham, M.D.
• Shelby G Wickhorst, O.D.
• Jodi Lynn Wicks
• Teghan Elizebeth Wicks
• Linda C Widing, DO
• Marc Douglass Widmer
• Tami Widmer, MA, LMHC, LPC
• George E Wiebe, MD
• Bonnie Ann Wiebeck Sweetland, LAC
• Kathryn Wiedeman, LPTA

• Athletic Trainer in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Athletic Trainer in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.