Provider Demographics
NPI:1407887094
Name:MANDHARE, VIDYA K (RN MSN FNPC)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:K
Last Name:MANDHARE
Suffix:
Gender:F
Credentials:RN MSN FNPC
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Other - First Name:
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Mailing Address - Street 1:2222 SIMON BOLIVAR AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-1460
Mailing Address - Country:US
Mailing Address - Phone:504-363-4711
Mailing Address - Fax:504-363-4741
Practice Address - Street 1:2222 SIMON BOLIVAR AVE
Practice Address - Street 2:FL 2
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1460
Practice Address - Country:US
Practice Address - Phone:504-658-2785
Practice Address - Fax:504-658-2784
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2017-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LARN087376163W00000X
LAAP020536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1782661Medicaid