Individual
MICHELLE VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15 PARKMAN ST, WANG BUILDING ROOM 745, BOSTON, MA 02114-3117
(617) 726-3303
Mailing address
2 EASTLAND RD, JAMAICA PLAIN, MA 02130-4617
(617) 699-1738
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
236195
MA
Other
Enumeration date
01/23/2007
Last updated
12/30/2013
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