Provider Demographics
NPI:1083243166
Name:HUCK, LYDIA J (RN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:J
Last Name:HUCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 GLENWAY ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-5232
Mailing Address - Country:US
Mailing Address - Phone:262-308-9290
Mailing Address - Fax:
Practice Address - Street 1:20 S PARK ST STE 505
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1348
Practice Address - Country:US
Practice Address - Phone:608-287-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI233797163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse