Provider Demographics
NPI:1710642954
Name:NAKONECHNA, LIDIYA
Entity Type:Individual
Prefix:
First Name:LIDIYA
Middle Name:
Last Name:NAKONECHNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33443 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4702
Mailing Address - Country:US
Mailing Address - Phone:248-873-7218
Mailing Address - Fax:
Practice Address - Street 1:33443 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48335-4702
Practice Address - Country:US
Practice Address - Phone:248-873-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist