Provider Demographics
NPI:1457903429
Name:VIDAL, ANN THERESA
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:THERESA
Last Name:VIDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CORAL ROSE DR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7503
Mailing Address - Country:US
Mailing Address - Phone:347-693-0526
Mailing Address - Fax:
Practice Address - Street 1:425 CORAL ROSE DR
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7503
Practice Address - Country:US
Practice Address - Phone:347-693-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health