Basic Information
| Provider Information | |||||||||
| NPI: | 1356839864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEAVY | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DNP, FNP-BC, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 356 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100114401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122717200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 356 W 18TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100114401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122717200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN60922171 | WA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 201806417RN | OR | N | Nursing Service Providers | Registered Nurse | 163W00000X | 60431 | ID | N | Nursing Service Providers | Registered Nurse | 163W00000X | 026.0138315 | VT | N | Nursing Service Providers | Registered Nurse | 163W00000X | R236864 | MD | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN72885 | ME | N | Nursing Service Providers | Registered Nurse | 163W00000X | 732749 | NY | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN710402 | PA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 156528 | CT | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN9488646 | FL | N | Nursing Service Providers | Registered Nurse | 163WC0200X | 26NR16179600 | NJ | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LF0000X | 11011435 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 26NJ01122600 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 95017969 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | F347285-01 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.