Individual
MS. LYDIA KAY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Contact information
Practice address
18855 VICTORY BLVD, ATTN: BILLING DEPARTMENT, RESEDA, CA 91335-6445
(818) 774-3354
(818) 757-4401
Mailing address
17075 DEVONSHIRE ST, STE 204, NORTHRIDGE, CA 91325-5408
(818) 368-8929
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
513626
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11725
N.P. FURNISHING
CA
01
—
513626
STATE LICENSE #
CA
01
—
P00705925
RAILROAD MEDICARE
CA
Enumeration date
07/28/2006
Last updated
03/07/2023
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