Individual
MRS. VIRGINIA L NIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1234 E DUPONT RD STE 1, FORT WAYNE, IN 46825-1545
(260) 266-6060
(260) 425-6395
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71004830A
IN
363L00000X
Nurse Practitioner
A0412039
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201211560
—
IN
01
—
P01307605
MEDICARE RR PTAN
IN
Enumeration date
08/16/2012
Last updated
10/17/2024
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