Healthcare Provider Details

I. General information

NPI: 1548858285
Provider Name (Legal Business Name): LYDIA A LARTEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5849 HARBOUR VIEW BLVD STE 250
SUFFOLK VA
23435-3769
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-3033
  • Fax: 757-312-3034
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178344
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: