Provider Demographics
NPI:1073197786
Name:LYDEN, ERICA C (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:C
Last Name:LYDEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 MONROE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1745
Mailing Address - Country:US
Mailing Address - Phone:570-213-9133
Mailing Address - Fax:570-209-8806
Practice Address - Street 1:814 MONROE ST STE 201
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1745
Practice Address - Country:US
Practice Address - Phone:570-213-9133
Practice Address - Fax:570-209-8806
Is Sole Proprietor?:No
Enumeration Date:2021-05-09
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023455363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health