Healthcare Provider Details

I. General information

NPI: 1740194646
Provider Name (Legal Business Name): LIDIA MARIA VAZQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LONE OAK RD
PADUCAH KY
42003-7901
US

IV. Provider business mailing address

5343 SHELLDRAKE LN
PADUCAH KY
42001-9554
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-2444
  • Fax:
Mailing address:
  • Phone: 270-978-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1169487
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: