Provider Demographics
NPI:1316710569
Name:WALDEN, LYDIA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:WALDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 ROBERT EVERETT CV APT 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-7437
Mailing Address - Country:US
Mailing Address - Phone:901-413-4789
Mailing Address - Fax:901-413-4789
Practice Address - Street 1:23 S IDLEWILD ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3926
Practice Address - Country:US
Practice Address - Phone:901-272-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program