Individual
MRS. KATHY VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Taxonomy
Speciality
Code
Description
License number
State
163WM0102X
Maternal Newborn Registered Nurse
Primary
72885
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57-6000286
—
SC
Enumeration date
08/15/2016
Last updated
08/15/2016
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