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General NPI Number Information
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NPI Number | 1548596232
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Entity Type | Individual
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Provider Name | LORI A. VIDAL CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/30/2009
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Last Update Date | 01/09/2021
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Provider Practice Location Address
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Address Line | 310 STOCK ST SUITE 4
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City | HANOVER
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State | PA
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Zip | 17331-2276
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Country | US
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Telephone | 717-316-3555
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Fax | 717-316-3556
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Provider Business Mailing Address
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Address Line | 310 STOCK ST SUITE 4
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City | HANOVER
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State | PA
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Zip | 17331-2276
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Country | US
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Telephone | 717-316-3555
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Fax | 717-316-3556
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP010540
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License Number State | PA
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