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General NPI Number Information
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NPI Number | 1285212803
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Entity Type | Individual
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Provider Name | LYDIA FENNESSY
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Gender | Female
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Dates
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Enumeration Date | 04/02/2021
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 1 NOLTE DR
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City | KITTANNING
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State | PA
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Zip | 16201-7111
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Country | US
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Telephone | 724-543-8657
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Fax |
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Provider Business Mailing Address
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Address Line | 610 GREENLEAF DR
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City | MONROEVILLE
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State | PA
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Zip | 15146-1153
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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