Provider Demographics
NPI:1881357325
Name:LYDY, RACHEL LYNN (CNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:LYDY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41201 SCHADDEN RD
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2249
Mailing Address - Country:US
Mailing Address - Phone:440-324-0451
Mailing Address - Fax:440-324-0441
Practice Address - Street 1:41201 SCHADDEN RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2249
Practice Address - Country:US
Practice Address - Phone:440-324-0451
Practice Address - Fax:440-324-0441
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily