Provider Demographics
NPI:1356839864
Name:PEAVY, LYDIA (DNP, FNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:PEAVY
Suffix:
Gender:F
Credentials:DNP, FNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:35 E 21ST ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6212
Practice Address - Country:US
Practice Address - Phone:212-530-0659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY732749163W00000X
FLRN9488646163W00000X, 163W00000X
TX978756163W00000X
NJ26NR16179600163WC0200X, 163WC0200X
CA95017969363LF0000X, 363LF0000X
NJ26NJ01122600363LF0000X, 363LF0000X
FL11011435363LF0000X, 363LF0000X
TX1117633363LF0000X
NYF347285-01363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine