Provider Demographics
NPI:1497014989
Name:ALBUQUERQUE, LYDIA HONORATA (MSN,ACNP-(BC),CCRN)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:HONORATA
Last Name:ALBUQUERQUE
Suffix:
Gender:F
Credentials:MSN,ACNP-(BC),CCRN
Other - Prefix:MRS
Other - First Name:LYDIA
Other - Middle Name:H
Other - Last Name:DCOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN,ACNP-BC,CCRN
Mailing Address - Street 1:40 COBBLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2037
Mailing Address - Country:US
Mailing Address - Phone:973-251-2751
Mailing Address - Fax:973-251-2751
Practice Address - Street 1:40 COBBLEWOOD RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2037
Practice Address - Country:US
Practice Address - Phone:973-251-2751
Practice Address - Fax:973-251-2751
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00372700363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care