Provider Demographics
NPI:1386196210
Name:VIDMAR, ROSE M (MSN, APNP, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:VIDMAR
Suffix:
Gender:F
Credentials:MSN, APNP, AGPCNP-BC
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:JUSZCZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N90W16620 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2166
Mailing Address - Country:US
Mailing Address - Phone:414-759-4632
Mailing Address - Fax:
Practice Address - Street 1:N90W16620 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2166
Practice Address - Country:US
Practice Address - Phone:414-759-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7363-33363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care