Provider Demographics
NPI:1447840905
Name:IKHINE, LYDIA URSULA X
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:URSULA
Last Name:IKHINE
Suffix:X
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-6226
Mailing Address - Country:US
Mailing Address - Phone:978-398-5796
Mailing Address - Fax:781-365-0139
Practice Address - Street 1:26 BEACON ST APT 24E
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3810
Practice Address - Country:US
Practice Address - Phone:978-398-5796
Practice Address - Fax:781-365-0139
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care