Provider Demographics
NPI:1730106675
Name:WARD, LIDA S (FNP)
Entity Type:Individual
Prefix:
First Name:LIDA
Middle Name:S
Last Name:WARD
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2560 N TEXAS ST STE C
Practice Address - Street 2:2560 N TEXAS ST STE C
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1649
Practice Address - Country:US
Practice Address - Phone:707-423-4355
Practice Address - Fax:707-423-4353
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2015-07-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA11648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily