Healthcare Provider Details

I. General information

NPI: 1407887094
Provider Name (Legal Business Name): VIDYA K MANDHARE RN MSN FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 SIMON BOLIVAR AVE FL 2
NEW ORLEANS LA
70113-1460
US

IV. Provider business mailing address

2222 SIMON BOLIVAR AVE FL 2
NEW ORLEANS LA
70113-1460
US

V. Phone/Fax

Practice location:
  • Phone: 504-658-2785
  • Fax: 504-658-2784
Mailing address:
  • Phone: 504-363-4711
  • Fax: 504-363-4741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP020536
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN087376
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: