Provider Demographics
NPI:1881353712
Name:ROBINSON, LYDIA GABRIELLA
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:GABRIELLA
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:GABRIELLA
Other - Last Name:OTTEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1404 TUSCULUM BLVD STE 2100
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4329
Mailing Address - Country:US
Mailing Address - Phone:423-783-5580
Mailing Address - Fax:
Practice Address - Street 1:1404 TUSCULUM BLVD STE 2100
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4329
Practice Address - Country:US
Practice Address - Phone:423-783-5580
Practice Address - Fax:423-783-5585
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000231637163WC0200X
TN31159363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily