Provider Demographics
NPI:1083367130
Name:ALLEN, LYDIA PEARL
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:PEARL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41453 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1211
Mailing Address - Country:US
Mailing Address - Phone:440-309-7169
Mailing Address - Fax:
Practice Address - Street 1:170 DELAWARE CIR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-7852
Practice Address - Country:US
Practice Address - Phone:440-387-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2022-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health