| NPI | 1215561956 |
|---|---|
| Former Name | STEPHANIE NICOLE LYDA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: OR AT-10169687) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2020-03-02 |