Healthcare Provider Details

I. General information

NPI: 1356710859
Provider Name (Legal Business Name): LYDIA L MAY ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W PARKS HWY STE 101
WASILLA AK
99654-6939
US

IV. Provider business mailing address

1301 W PARKS HWY STE 101
WASILLA AK
99654-6939
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-7781
  • Fax:
Mailing address:
  • Phone: 907-357-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number102672
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: