=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962925628
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYDIA COLE FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2017
-----------------------------------------------------
Last Update Date | 02/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 W AYLESBURY RD STE 600
-----------------------------------------------------
City | TIMONIUM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-4168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-575-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1329 N DUPONT ST APT 2
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-4076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-233-2305
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP031851
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | L1-0050652
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ACOO7372
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------