Individual
LIDA KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1775 DELCO PARK DRIVE, KETTERING, OH 45420
(937) 299-2587
(937) 299-0124
Mailing address
1775 DELCO PARK DRIVE, KETTERING, OH 45420
(937) 299-2587
(937) 299-0124
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN107296NP1985
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2226791
—
OH
Enumeration date
10/03/2006
Last updated
07/08/2007
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