Provider Demographics
NPI:1619101946
Name:SWEENEY, LYDIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8097
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-8097
Mailing Address - Country:US
Mailing Address - Phone:845-383-1974
Mailing Address - Fax:
Practice Address - Street 1:166 SMITH AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3616
Practice Address - Country:US
Practice Address - Phone:845-383-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211383-I164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse