Provider Demographics
NPI:1508098302
Name:PATRICK-DELUCA, LYDIA ANN (MSN RN APN-C)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
Last Name:PATRICK-DELUCA
Suffix:
Gender:F
Credentials:MSN RN APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 PORTER PL
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2036
Mailing Address - Country:US
Mailing Address - Phone:973-865-4632
Mailing Address - Fax:
Practice Address - Street 1:88 PORTER PL
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2036
Practice Address - Country:US
Practice Address - Phone:973-865-4632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00228000363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health