Provider Demographics
NPI:1366673527
Name:LYDIC, VALERIE (LPN)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:LYDIC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9599
Mailing Address - Country:US
Mailing Address - Phone:440-478-0638
Mailing Address - Fax:
Practice Address - Street 1:3534 MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OH
Practice Address - Zip Code:44081-9599
Practice Address - Country:US
Practice Address - Phone:440-478-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-106864164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse