Provider Demographics
NPI:1902032287
Name:AMPAH-DAVIES, LYDIA (RN)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:AMPAH-DAVIES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:AMAPH-DAVIES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:794 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-5331
Mailing Address - Country:US
Mailing Address - Phone:917-519-7650
Mailing Address - Fax:201-357-5205
Practice Address - Street 1:794 JOHN ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-5331
Practice Address - Country:US
Practice Address - Phone:917-519-7650
Practice Address - Fax:201-357-5205
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY574953163W00000X
NJ26NR12855700163W00000X, 3140N1450X
NJ26NR122855700374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No374U00000XNursing Service Related ProvidersHome Health Aide