Provider Demographics
NPI:1255685889
Name:WIDMER, MICHELLE B (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:B
Last Name:WIDMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:B
Other - Last Name:BUECHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-1000
Practice Address - Country:US
Practice Address - Phone:781-744-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60310471363L00000X
NH071057-23363L00000X
MARN2270499363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100668Medicaid
WA0302719OtherSTATE L&I
NH3100668Medicaid
WA0302721OtherSTATE L&I
WA0302724OtherSTATE L&I
WA0302714OtherSTATE L&I
WA0302727OtherSTATE L&I
WA0302723OtherSTATE L&I
WA0302714OtherSTATE L&I
NH3100668Medicaid