Basic Information
| Provider Information | |||||||||
| NPI: | 1932395738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAPA-WILSON | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | MARTHA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | CPNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILSON | ||||||||
| OtherFirstName: | LYDIA | ||||||||
| OtherMiddleName: | MARTHA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | CPNP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3130 SE MILITARY DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782233892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103703176 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3130 SE MILITARY DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782233892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103703176 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2007 | ||||||||
| LastUpdateDate: | 02/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 529878 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.