Provider Demographics
NPI:1578702825
Name:HAENICHEN, LYDIA LOUISE (LPN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:LOUISE
Last Name:HAENICHEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:LOUISE
Other - Last Name:HAMLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:96 E ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2705
Mailing Address - Country:US
Mailing Address - Phone:315-254-7061
Mailing Address - Fax:
Practice Address - Street 1:96 E ONEIDA ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2705
Practice Address - Country:US
Practice Address - Phone:315-254-7061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283500-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse