Provider Demographics
NPI:1033240031
Name:VIDMAR, LESLIE Z (CNP)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:Z
Last Name:VIDMAR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 CRANWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-1416
Mailing Address - Country:US
Mailing Address - Phone:440-665-0024
Mailing Address - Fax:
Practice Address - Street 1:4510 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5757
Practice Address - Country:US
Practice Address - Phone:440-665-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN190839363LA2200X
OHCNP.09893207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health