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NPI Code Detail

MEDICARE: MS. JONI SUZANNE LYDIC F.N.P.

MEDICARE: MS. JONI SUZANNE LYDIC F.N.P.
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
1363LF0000XFamily Nurse PractitionerRN041417AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518964782
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JONI SUZANNE LYDIC F.N.P.
Provider Business Mailing Address
First Line : 2302 N 75TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85035-1216
Country : US
Telephone Number : 623-849-7500
Fax Number : 623-849-7588
Provider Business Practice Location Address
First Line : 2302 N 75TH AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85035-1216
Country : US
Telephone Number : 623-849-7500
Fax Number : 623-849-7588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2005
Last Update Date : 02/29/2012

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