Individual
SHANNON BRIDGET LYDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
409 W BROADWAY, BOSTON, MA 02127-2245
(617) 269-7500
Mailing address
409 W BROADWAY, BOSTON, MA 02127-2245
(617) 269-7500
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
RN2335175
MA
363L00000X
Nurse Practitioner
Primary
RN2335175
MA
Other
Enumeration date
07/12/2022
Last updated
10/18/2023
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