Provider Demographics
NPI:1033598586
Name:CHURCHILL, LYDIA (RN BSN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:CHURCHILL
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 PURDY ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4418
Mailing Address - Country:US
Mailing Address - Phone:646-675-3293
Mailing Address - Fax:
Practice Address - Street 1:1334 PURDY ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4418
Practice Address - Country:US
Practice Address - Phone:646-675-3293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646928163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse