Provider Demographics
NPI:1871238295
Name:GORBETT, LYDIA REYNALDA (PMHNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:REYNALDA
Last Name:GORBETT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 S COUNTY ROAD 925 W
Mailing Address - Street 2:
Mailing Address - City:MEDORA
Mailing Address - State:IN
Mailing Address - Zip Code:47260-9707
Mailing Address - Country:US
Mailing Address - Phone:812-966-0186
Mailing Address - Fax:
Practice Address - Street 1:4014 S COUNTY ROAD 925 W
Practice Address - Street 2:
Practice Address - City:MEDORA
Practice Address - State:IN
Practice Address - Zip Code:47260-9707
Practice Address - Country:US
Practice Address - Phone:812-966-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012451363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health