Provider Demographics
NPI:1629645106
Name:WEISS, LYDIA MICHELLE LEMMENES (DNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:MICHELLE LEMMENES
Last Name:WEISS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:MICHELLE
Other - Last Name:LEMMENES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2135 MUIR FIELD RD APT 5
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2153
Mailing Address - Country:US
Mailing Address - Phone:920-382-5533
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:920-382-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11061-33363L00000X
WI200913163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse