Provider Demographics
NPI:1528403458
Name:LEMAIRE, VIDA A (CRNP)
Entity Type:Individual
Prefix:
First Name:VIDA
Middle Name:A
Last Name:LEMAIRE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEADOWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2858
Mailing Address - Country:US
Mailing Address - Phone:215-809-8606
Mailing Address - Fax:215-361-7579
Practice Address - Street 1:2026 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1004
Practice Address - Country:US
Practice Address - Phone:215-368-4434
Practice Address - Fax:215-361-7579
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027016363LP0808X
PASP012667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP012667OtherMED. LIC. NUMBER
PASP027016OtherNP PSYCH/MENTAL HEALTH