Provider Demographics
NPI:1194152157
Name:MANDIZVIDZA, VIMBAI (RN)
Entity type:Individual
Prefix:MR
First Name:VIMBAI
Middle Name:
Last Name:MANDIZVIDZA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34440 RIDGE RD
Mailing Address - Street 2:SUITE C 14
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3087
Mailing Address - Country:US
Mailing Address - Phone:440-341-4930
Mailing Address - Fax:
Practice Address - Street 1:34440 RIDGE RD
Practice Address - Street 2:SUITE C 14
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3087
Practice Address - Country:US
Practice Address - Phone:440-341-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH396440163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse