MEDICARE: LYDIA NAHVALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.0039951	OH

General Provider Information

NPI Number	:	1104700798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA NAHVALA

Provider Business Mailing Address
First Line	:	34200 RIDGE RD APT 317
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-2959
Country	:	US
Telephone Number	:	440-622-8842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 BISHOP RD
Second Line	:
City	:	WICKLIFFE
State	:	OH
Zip	:	44092-2518
Country	:	US
Telephone Number	:	440-944-9400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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Directions to “ LYDIA NAHVALA ” Practice Location

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