Provider Demographics
NPI:1285146183
Name:SCHAAKE, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:SCHAAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:DISSELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2852 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1035
Mailing Address - Country:US
Mailing Address - Phone:217-740-6993
Mailing Address - Fax:
Practice Address - Street 1:7801 MISSION CENTER CT STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1314
Practice Address - Country:US
Practice Address - Phone:619-738-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007878363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner