Provider Demographics
NPI:1568766038
Name:JODREY, LYDIA (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:JODREY
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:MISS
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:STUSHEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 S WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6423
Mailing Address - Country:US
Mailing Address - Phone:847-749-4237
Mailing Address - Fax:
Practice Address - Street 1:121 S WILKE RD
Practice Address - Street 2:#600
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1533
Practice Address - Country:US
Practice Address - Phone:847-259-8379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008114363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics