Provider Demographics
NPI:1760712822
Name:AMOROSO, VIDETTE MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:VIDETTE
Middle Name:MARIE
Last Name:AMOROSO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12977 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-4236
Mailing Address - Country:US
Mailing Address - Phone:440-465-1473
Mailing Address - Fax:
Practice Address - Street 1:12977 W 130TH ST
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4236
Practice Address - Country:US
Practice Address - Phone:440-465-1473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN115195164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse