Provider Demographics
NPI:1851525679
Name:HARRIS, LYDIA (RN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 MANCHESTER WAY DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8877
Mailing Address - Country:US
Mailing Address - Phone:317-560-2809
Mailing Address - Fax:614-420-2230
Practice Address - Street 1:3406 MANCHESTER WAY DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8877
Practice Address - Country:US
Practice Address - Phone:317-560-2809
Practice Address - Fax:614-468-2230
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.347120163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator