Provider Demographics
NPI:1790390854
Name:KIDWILER, MICHELLE AISLINN (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:AISLINN
Last Name:KIDWILER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TRENT DRIVE DUKE SOUTH BASEMENT OFFICE 0237
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-681-6759
Mailing Address - Fax:
Practice Address - Street 1:200 TRENT DRIVE DUKE SOUTH BASEMENT OFFICE 0237
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-681-6759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC342012163W00000X
TN233285163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse