Provider Demographics
NPI:1760118020
Name:WARREN, LYDIA ANN (LAC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
Last Name:WARREN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:ANN
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2812 NW 57TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7064
Mailing Address - Country:US
Mailing Address - Phone:405-651-5990
Mailing Address - Fax:
Practice Address - Street 1:2812 NW 57TH ST STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7064
Practice Address - Country:US
Practice Address - Phone:405-651-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01441171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist