Provider Demographics
NPI:1669684924
Name:BOLDUC-MARDEN, LYDIA (NP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:BOLDUC-MARDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4460 MAYFLOWER HL
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-8844
Mailing Address - Country:US
Mailing Address - Phone:207-859-4460
Mailing Address - Fax:207-859-4475
Practice Address - Street 1:4460 MAYFLOWER HL
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-8844
Practice Address - Country:US
Practice Address - Phone:207-859-4460
Practice Address - Fax:207-859-4475
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER021747363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELYDIA5694Medicare UPIN