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General NPI Number Information
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NPI Number | 1730075185
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Entity Type | Individual
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Provider Name | MATTHEW LYDON DNP, CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 100 BREWSTER BLVD
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City | CAMP LEJEUNE
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State | NC
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Zip | 28547-2575
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Country | US
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Telephone | 910-450-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 102 MOONSTONE CT
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City | JACKSONVILLE
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State | NC
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Zip | 28546-8740
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Country | US
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Telephone | 904-607-4904
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 153627
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License Number State | NC
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