Provider Demographics
NPI:1114789971
Name:LIDDER, PALLAVI (LVN)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:LIDDER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:PALLAVI
Other - Middle Name:
Other - Last Name:LIDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2833 EATON RD UNIT 124
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5650
Mailing Address - Country:US
Mailing Address - Phone:530-300-5497
Mailing Address - Fax:
Practice Address - Street 1:2833 EATON RD UNIT 124
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5650
Practice Address - Country:US
Practice Address - Phone:530-300-5497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278296164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse