Healthcare Provider Details

I. General information

NPI: 1265959308
Provider Name (Legal Business Name): LYDIA HENRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 BEAR CORBITT RD
BEAR DE
19701-1323
US

IV. Provider business mailing address

255 SAFFRON CIR
MIDDLETOWN DE
19709-9199
US

V. Phone/Fax

Practice location:
  • Phone: 302-454-2400
  • Fax: 302-454-5440
Mailing address:
  • Phone: 302-376-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL1-0021782
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: