Provider Demographics
NPI:1700474004
Name:GAO, LYDIA (FNP)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5921
Mailing Address - Country:US
Mailing Address - Phone:559-584-6499
Mailing Address - Fax:559-584-8124
Practice Address - Street 1:1360 BAILEY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5921
Practice Address - Country:US
Practice Address - Phone:559-584-6499
Practice Address - Fax:559-584-8124
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016278363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner