Provider Demographics
NPI:1033538509
Name:TANNEY, LYDIA G (LAT)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:G
Last Name:TANNEY
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3046 CONESTA DR APT 1
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4986
Mailing Address - Country:US
Mailing Address - Phone:920-323-0880
Mailing Address - Fax:
Practice Address - Street 1:3046 CONESTA DR APT 1
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-4986
Practice Address - Country:US
Practice Address - Phone:920-323-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer