Provider Demographics
NPI:1194391839
Name:WIDMER, MEGHAN
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:WIDMER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32730 WALKER RD STE H
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2235
Mailing Address - Country:US
Mailing Address - Phone:440-930-4955
Mailing Address - Fax:440-930-4960
Practice Address - Street 1:32730 WALKER RD STE H
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2235
Practice Address - Country:US
Practice Address - Phone:440-930-4955
Practice Address - Fax:440-930-4960
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF12200425363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily