Provider Demographics
NPI:1326116633
Name:VIDRINE, MAUREEN FRANCES (APRN-PMH)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:FRANCES
Last Name:VIDRINE
Suffix:
Gender:F
Credentials:APRN-PMH
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:FRANCES
Other - Last Name:ABBATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:880 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8109
Mailing Address - Country:US
Mailing Address - Phone:770-784-9777
Mailing Address - Fax:
Practice Address - Street 1:10385 HWY 278
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014
Practice Address - Country:US
Practice Address - Phone:770-784-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN076382163W00000X, 363LP0808X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
019589102OtherANCC CNS
019589102OtherANCC CNS