Provider Demographics
NPI:1740098987
Name:NAZZIWA, LYDIA NAZZIWA MARTHA
Entity type:Individual
Prefix:
First Name:LYDIA NAZZIWA
Middle Name:MARTHA
Last Name:NAZZIWA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 NE JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-1734
Mailing Address - Country:US
Mailing Address - Phone:978-395-6111
Mailing Address - Fax:971-864-6968
Practice Address - Street 1:835 NE JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-1734
Practice Address - Country:US
Practice Address - Phone:978-395-6111
Practice Address - Fax:971-864-6968
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0000000139372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion