Individual
LYDIA HELEN NEFEDOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, AGNP-BC
Contact information
Practice address
3463 MAGIC DR STE T21, SAN ANTONIO, TX 78229-3621
(210) 614-8101
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
1075580
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN.CNP.0040200
OH
363LG0600X
Gerontology Nurse Practitioner
71013911A
IN
363LG0600X
Gerontology Nurse Practitioner
APRN002369
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540884
MEDICARE PTAN
IN
Enumeration date
11/28/2016
Last updated
03/11/2026
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