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General NPI Number Information
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NPI Number | 1275654071
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Entity Type | Individual
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Provider Name | LYDIA MARQUEZ PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 2293 N MAIN ST
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City | CROWN POINT
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State | IN
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Zip | 46307-1854
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Country | US
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Telephone | 219-755-3385
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Fax |
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Provider Business Mailing Address
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Address Line | 2293 N MAIN ST
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City | CROWN POINT
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State | IN
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Zip | 46307-1854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-002630
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10001356A
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License Number State | IN
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