Matthew Charles Wideman, DNP, RN, AGNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

4704287664NSA2001O Issued in MI

Practice address

1727 W Bluewater Hwy
Ionia, MI 48846-8647

Phone

(616) 527-2510

NPI assigned

Apr 9, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586390400000",
    "number": "1871112904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1727 W BLUEWATER HWY",
            "city": "IONIA",
            "state": "MI",
            "postal_code": "488468647",
            "telephone_number": "616-460-0071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 W BLUEWATER HWY",
            "city": "IONIA",
            "state": "MI",
            "postal_code": "488468647",
            "telephone_number": "616-527-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDEMAN",
        "first_name": "MATTHEW",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DNP, RN, AGNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-09",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704287664NSA2001O",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Widemanm1@michigan.gov",
            "affiliation": "N",
            "endpointDescription": "Secure Work Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email",
            "address_1": "1727 W Bluewater Hwy",
            "city": "Ionia",
            "state": "MI",
            "country_code": "US",
            "postal_code": "488468647",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bret Wetzel, R.PH.
• Zachariah Whitcomb, DO
• Adam D White, PHARMD
• Nicole White, BCBA
• Tania Denise White, LMSW
• Kenneth A Williams, CRNA
• Heather Wilson
• Susan E Wizorek
• Caleb Wood
• Brianna Woodard, LMSW

• Nurse Practitioner in Ionia, MI
• Providers in Ionia, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; 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.