Provider Demographics
NPI:1720407810
Name:WIDMER, AMANDA (COMS)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:WIDMER
Suffix:
Gender:F
Credentials:COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 N CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6022
Mailing Address - Country:US
Mailing Address - Phone:559-903-7678
Mailing Address - Fax:
Practice Address - Street 1:5000 S. 5TH AVE
Practice Address - Street 2:HINES VA HOSPITAL, BLIND REHABILITATION CTR BLDG 113
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255R0406XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistRehabilitation, Blind