Provider Demographics
NPI:1003064296
Name:VANGEEST, LIDA CORNELIA
Entity Type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:CORNELIA
Last Name:VANGEEST
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LIDA
Other - Middle Name:CORNELIA
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:22161 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-7038
Mailing Address - Country:US
Mailing Address - Phone:971-344-1424
Mailing Address - Fax:
Practice Address - Street 1:22161 N 6TH ST
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-7038
Practice Address - Country:US
Practice Address - Phone:971-344-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-31
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310946163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health