Provider Demographics
NPI:1255210019
Name:VIDMAR, AUDREY
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:VIDMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BEAVER VALLEY MALL
Mailing Address - Street 2:ROUTE 18
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061
Mailing Address - Country:US
Mailing Address - Phone:814-229-5282
Mailing Address - Fax:
Practice Address - Street 1:110 BEAVER VALLEY MALL
Practice Address - Street 2:ROUTE 18
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061
Practice Address - Country:US
Practice Address - Phone:814-229-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator