Provider Demographics
NPI:1356710859
Name:MAY, LYDIA L (ANP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:L
Last Name:MAY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W PARKS HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6939
Mailing Address - Country:US
Mailing Address - Phone:907-357-7781
Mailing Address - Fax:
Practice Address - Street 1:1301 W PARKS HWY STE 101
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6939
Practice Address - Country:US
Practice Address - Phone:907-357-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK102672363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1631831Medicaid
AK102672OtherALASKA BOARD OF NURSING LICENSE
AK1631831Medicaid