Provider Demographics
NPI:1275948622
Name:GUGSA, LYDIA (CRNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:GUGSA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12203 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1024
Mailing Address - Country:US
Mailing Address - Phone:301-213-4277
Mailing Address - Fax:
Practice Address - Street 1:1004 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5026
Practice Address - Country:US
Practice Address - Phone:443-261-5963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1025079163W00000X
MDR197771363LP0808X
DCNP1025079363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse