| Doctor Name: | MS. LYDIA KAY WILSON |
| NPI Number: | 1093729824 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | GNP |
| License Number: | 513626 |
| Business Practice Address: | 18855 Victory Blvd Attn: Billing Department Reseda, CA - 913356445 |
| Business Phone Number: | 8187743354 |
| Business Fax Number: | 8187574401 |
| Mailing Address: | 21436 Providencia St, WOODLAND HILLS |
| State: | CA |
| Postal Code: | 913644308 |
| Phone Number: | 8187020232 |
| Fax Number: | |
| NPI Enumeration Date: | 07/28/2006 |
| NPI Last Update Date: | 12/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 513626 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |