Provider Demographics
NPI:1225681695
Name:VAN DYKE, LYDIA JEANETTE (APRN CNM)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:JEANETTE
Last Name:VAN DYKE
Suffix:
Gender:F
Credentials:APRN CNM
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1032 MCCALLIE AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2836
Mailing Address - Country:US
Mailing Address - Phone:423-266-6116
Mailing Address - Fax:423-498-3633
Practice Address - Street 1:1511 GUNBARREL RD STE 111
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3897
Practice Address - Country:US
Practice Address - Phone:423-266-6116
Practice Address - Fax:423-498-3633
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN25989367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife