Provider Demographics
NPI:1467451930
Name:BERRONE, LIDIA MARIA (NP)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:MARIA
Last Name:BERRONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 WOODMAN DR STE 205
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-1171
Mailing Address - Country:US
Mailing Address - Phone:937-502-4567
Mailing Address - Fax:609-293-0270
Practice Address - Street 1:3085 WOODMAN DR STE 205
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1171
Practice Address - Country:US
Practice Address - Phone:937-502-4567
Practice Address - Fax:609-293-0270
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.07521363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2540585Medicaid
OH000000327604OtherANTHEM
OHBENP15226Medicare PIN
Q12240Medicare UPIN