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General NPI Number Information
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NPI Number | 1669830139
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Entity Type | Individual
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Provider Name | MICHELLE DARA WIDDOWS PMHNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 105 TECHNOLOGY DR FL 2
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City | TRUMBULL
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State | CT
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Zip | 06611-6348
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Country | US
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Telephone | 475-228-0961
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Fax | 203-283-6490
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Provider Business Mailing Address
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Address Line | 105 TECHNOLOGY DR FL 2
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City | TRUMBULL
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State | CT
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Zip | 06611-6348
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Country | US
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Telephone | 475-228-0961
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Fax | 203-283-6490
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12.014410
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 606396
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 10.146391
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License Number State | CT
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