MEDICARE: LYDIA ANNA MILLER FNP

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	363LF0000X	Family Nurse Practitioner	RN2386909	MA

General Provider Information

NPI Number	:	1679387823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA ANNA MILLER FNP

Provider Business Mailing Address
First Line	:	30 SHERWOOD DR
Second Line	:
City	:	BRADFORD
State	:	MA
Zip	:	01835-8127
Country	:	US
Telephone Number	:	978-914-5458
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 TURNPIKE ST STE 300A
Second Line	:
City	:	NORTH ANDOVER
State	:	MA
Zip	:	01845-5093
Country	:	US
Telephone Number	:	978-269-0030
Fax Number	:

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

Provider Enumeration Date	:	02/06/2025
Last Update Date	:	10/17/2025

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