Provider Demographics
NPI:1992297626
Name:REDICK, LYDIA ANN (CNP)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:ANN
Last Name:REDICK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-6566
Mailing Address - Country:US
Mailing Address - Phone:303-859-0854
Mailing Address - Fax:970-612-8013
Practice Address - Street 1:4435 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-6566
Practice Address - Country:US
Practice Address - Phone:303-859-0854
Practice Address - Fax:970-612-8013
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily