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General NPI Number Information
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NPI Number | 1730224924
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Entity Type | Individual
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Provider Name | ELIZABETH H. WIDASKI RN
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 4200 W MEMORIAL RD STE 410
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8305
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Country | US
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Telephone | 405-608-3866
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Fax | 405-607-2976
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Provider Business Mailing Address
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Address Line | 4200 W MEMORIAL RD STE 410
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-8305
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Country | US
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Telephone | 405-608-3866
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Fax | 405-607-2976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 632316
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 91951
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License Number State | OK
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