Individual
LYDIA GENNIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1004 SHORELINE DR, BAINBRIDGE, GA 39817-8393
(850) 363-8735
Mailing address
1004 SHORELINE DR, BAINBRIDGE, GA 39817-8393
(850) 363-8735
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5214585
FL
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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