Provider Demographics
NPI:1952799447
Name:LIDGE, PARIS
Entity Type:Individual
Prefix:
First Name:PARIS
Middle Name:
Last Name:LIDGE
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 1:75 N PORTAGE PATH
Mailing Address - Street 2:APT. 100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1101
Mailing Address - Country:US
Mailing Address - Phone:330-812-0262
Mailing Address - Fax:
Practice Address - Street 1:75 N PORTAGE PATH
Practice Address - Street 2:APT. 100
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1101
Practice Address - Country:US
Practice Address - Phone:330-812-0262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH318328163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse