Provider Demographics
NPI:1033415583
Name:ZELLERS, LYDIA ANNA (PA)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANNA
Last Name:ZELLERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:ANNA
Other - Last Name:VAN WINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:301 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362
Mailing Address - Country:US
Mailing Address - Phone:570-295-4969
Mailing Address - Fax:
Practice Address - Street 1:LYSTER ARMY HEALTH CLINIC
Practice Address - Street 2:301 ANDREWS AVE
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:800-261-7193
Practice Address - Fax:334-255-7710
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-01
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider