Individual
MRS. MARY ELLEN LYDEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4 BERKSHIRE BLVD, BETHEL, CT 06801-1001
(203) 826-3159
(203) 775-6810
Mailing address
4 BERKSHIRE BLVD, BETHEL, CT 06801-1001
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
001563
CT
Other
Enumeration date
12/07/2007
Last updated
12/07/2007
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