Provider Demographics
NPI:1639984461
Name:LYDIATT, JACQUELINE JUNE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JUNE
Last Name:LYDIATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1841 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1712
Mailing Address - Country:US
Mailing Address - Phone:302-326-3229
Mailing Address - Fax:
Practice Address - Street 1:1841 CLAY ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1712
Practice Address - Country:US
Practice Address - Phone:302-326-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion