Individual
LIDIA EGGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
018293
NY
363A00000X
Physician Assistant
54117
CA
363A00000X
Physician Assistant
60921045
WA
363A00000X
Physician Assistant
Primary
AMD-752
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4071550
—
NY
Enumeration date
08/22/2013
Last updated
03/16/2021
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