1932447455 NPI number — MRS. MAUREEN ANNETTE VIDNOVIC RN

Table of content: MRS. MAUREEN ANNETTE VIDNOVIC RN (NPI 1932447455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932447455 NPI number — MRS. MAUREEN ANNETTE VIDNOVIC RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIDNOVIC
Provider First Name:
MAUREEN
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VIDNOVIC
Provider Other First Name:
MAUREEN
Provider Other Middle Name:
ANNETTE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932447455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 PELLIS RD
Provider Second Line Business Mailing Address:
SUITE2A
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-4700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-836-0400
Provider Business Mailing Address Fax Number:
724-836-6422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 PELLIS RD
Provider Second Line Business Practice Location Address:
SUITE2A
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-836-0400
Provider Business Practice Location Address Fax Number:
724-836-6422
Provider Enumeration Date:
01/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WM0705X , with the licence number:  84562 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WM0705X , with the licence number: RN191125L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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