Healthcare Provider Details

I. General information

NPI: 1679986798
Provider Name (Legal Business Name): KATE ELIZABETH LYDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 JOLIN ST
LEWISTON ME
04240-1801
US

IV. Provider business mailing address

8 JOLIN ST
LEWISTON ME
04240-1801
US

V. Phone/Fax

Practice location:
  • Phone: 207-740-8105
  • Fax:
Mailing address:
  • Phone: 207-740-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: