Individual
LYDIA KAY LYALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
12711 SE MILL PLAIN BLVD, VANCOUVER, WA 98684-6053
(360) 896-4484
Mailing address
12711 SE MILL PLAIN BLVD, VANCOUVER, WA 98684-6053
(360) 896-4484
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-0798039
KAISER PERMANENTE
WA
Enumeration date
10/23/2018
Last updated
10/23/2018
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