Provider Demographics
NPI:1902079411
Name:STINEMEYER, LYDIA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:ANN
Last Name:STINEMEYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 25
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817
Mailing Address - Country:US
Mailing Address - Phone:303-335-7637
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH MUNDO
Practice Address - Street 2:JICARILLA INDIAN HEALTH SERVICE CLINIC
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528
Practice Address - Country:US
Practice Address - Phone:575-759-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO176494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse