Healthcare Provider Details

I. General information

NPI: 1952051922
Provider Name (Legal Business Name): LYDIA BAKAKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 STONEFIELD DR
BEREA OH
44017-3129
US

IV. Provider business mailing address

100 WASHINGTON AVE S STE 1210
MINNEAPOLIS MN
55401-2104
US

V. Phone/Fax

Practice location:
  • Phone: 440-625-0955
  • Fax:
Mailing address:
  • Phone: 866-492-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0031060
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number0031060
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: