Provider Demographics
NPI:1083889034
Name:WIDGA, ANNE C (RD, LMNT, CDE)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:WIDGA
Suffix:
Gender:F
Credentials:RD, LMNT, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-4802
Mailing Address - Country:US
Mailing Address - Phone:402-481-6305
Mailing Address - Fax:402-481-6361
Practice Address - Street 1:7501 S 27TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-4802
Practice Address - Country:US
Practice Address - Phone:402-481-6305
Practice Address - Fax:402-481-6361
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE654133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE275945Medicare UPIN