Provider Demographics
NPI:1013457381
Name:SHERMAN, LYDIA NYAKONU (CNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:NYAKONU
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 OLSON MEMORIAL HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4888
Mailing Address - Country:US
Mailing Address - Phone:651-271-1665
Mailing Address - Fax:612-870-5491
Practice Address - Street 1:7500 OLSON MEMORIAL HWY STE 300
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4888
Practice Address - Country:US
Practice Address - Phone:651-271-1665
Practice Address - Fax:612-999-1767
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP5041363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1013457381Medicaid