Individual
LYDIA R EMNOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2654 S ONEIDA ST, STE 102, GREEN BAY, WI 54304-5330
(888) 938-3838
(888) 919-1083
Mailing address
10001 W INNOVATION DR STE 200, MILWAUKEE, WI 53226-4851
(888) 938-3838
(888) 919-1083
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
014440
NY
363A00000X
Physician Assistant
Primary
7148
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014440
NYS PHYSICIAN ASSISTANT LICENSE
NY
01
—
7148
WI STATE LICENSE
WI
Enumeration date
01/19/2011
Last updated
03/07/2023
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