Individual
EDWARD VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
2331 W CARSON RD, PHOENIX, AZ 85041-6408
(602) 516-2494
Mailing address
2331 W CARSON RD, PHOENIX, AZ 85041-6408
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP11639
AZ
Other
Enumeration date
08/09/2018
Last updated
11/21/2018
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