Provider Demographics
NPI:1093565764
Name:VIDAL, LIDIA L (FNP)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:L
Last Name:VIDAL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 DIVISION AVE # 2
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3621
Mailing Address - Country:US
Mailing Address - Phone:973-931-9777
Mailing Address - Fax:
Practice Address - Street 1:83 DIVISION AVE # 2
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-3621
Practice Address - Country:US
Practice Address - Phone:973-931-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJF03240452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily