Tracy Marie Widmer, CRNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

UP006244D Issued in PA

Practice address

3400 Civic Center Blvd
Philadelphia, PA 19104-4306

Phone

(215) 590-1000

NPI assigned

Jul 2, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214956800000",
    "number": "1760644546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 STEPHANIE CT",
            "city": "FRANKLINVILLE",
            "state": "NJ",
            "postal_code": "083222699",
            "telephone_number": "856-629-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 CIVIC CENTER BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044306",
            "telephone_number": "215-590-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDMER",
        "first_name": "TRACY",
        "middle_name": "MARIE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "PA",
            "license": "UP006244D",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexis Inez Wickersham, M.D.
• Lori Lee Widener, LCSW
• Jan Neil Widerman, D.O.
• Olivia Mae Widger, M.D.
• Crystal L Widmann, LPC
• Caryn S Widrick, MT-BC
• Julianne Leonarda Wiebalk, MS
• Peter Wieczorek, DO
• Nancy L Wiedemer, CRNP
• Quinn Wiedemer

• Pediatric Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Pediatric Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.