Provider Demographics
NPI:1790899680
Name:GLIDDEN, MICHELLE MURRAY (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MURRAY
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:MARIE
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1000 ASYLUM AVE
Mailing Address - Street 2:SUITE 2109A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1770
Mailing Address - Country:US
Mailing Address - Phone:860-714-6581
Mailing Address - Fax:
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:CARDIOLOGY
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-4202
Practice Address - Fax:860-714-8001
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3226363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
400003226CTOtherANTHEM
032260OtherCT
CT004251170Medicaid
2V6522OtherHEALTH NET
00425117000OtherEDS BLUE CARE
P3605515OtherOXFORD
2V6522OtherHEALTH NET
P3605515OtherOXFORD