Provider Demographics
NPI:1710107792
Name:WU, LYDIA LAI-WA (NP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:LAI-WA
Last Name:WU
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 1:506 BROOKWOOD DR
Mailing Address - Street 2:APT. # Q6
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4917
Mailing Address - Country:US
Mailing Address - Phone:410-262-2147
Mailing Address - Fax:
Practice Address - Street 1:506 BROOKWOOD DR
Practice Address - Street 2:APT. # Q6
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4917
Practice Address - Country:US
Practice Address - Phone:410-262-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704256969363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner