Provider Demographics
NPI:1285022988
Name:MARTIN, LYDIA ANNE (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 OGLETOWN STANTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2081
Mailing Address - Country:US
Mailing Address - Phone:302-225-0451
Mailing Address - Fax:302-225-0470
Practice Address - Street 1:34434 KING STREET ROW STE 4
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4987
Practice Address - Country:US
Practice Address - Phone:302-360-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0042162163W00000X
DELG-0011835363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse