Provider Demographics
NPI:1932447455
Name:VIDNOVIC, MAUREEN ANNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:ANNETTE
Last Name:VIDNOVIC
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MAUREEN
Other - Middle Name:ANNETTE
Other - Last Name:VIDNOVIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:410 PELLIS RD
Mailing Address - Street 2:SUITE2A
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4700
Mailing Address - Country:US
Mailing Address - Phone:724-836-0400
Mailing Address - Fax:724-836-6422
Practice Address - Street 1:410 PELLIS RD
Practice Address - Street 2:SUITE2A
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4700
Practice Address - Country:US
Practice Address - Phone:724-836-0400
Practice Address - Fax:724-836-6422
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV84562163WM0705X
PARN191125L163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical