Provider Demographics
NPI:1992207112
Name:LYDICK, JENNY BARBO (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:BARBO
Last Name:LYDICK
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 1:4113 NE BONNIE DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-5854
Mailing Address - Country:US
Mailing Address - Phone:360-433-8026
Mailing Address - Fax:
Practice Address - Street 1:4113 NE BONNIE DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5854
Practice Address - Country:US
Practice Address - Phone:360-433-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-03
Last Update Date:2018-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60401758163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse