Provider Demographics
NPI:1871277137
Name:SIMRILL, LYDIA LEA ODLIN
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:LEA ODLIN
Last Name:SIMRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:LEA
Other - Last Name:ODLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 MATTHEWS COMMONS DR APT 12
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6136
Mailing Address - Country:US
Mailing Address - Phone:207-210-0498
Mailing Address - Fax:
Practice Address - Street 1:924 MATTHEWS COMMONS DR APT 12
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6136
Practice Address - Country:US
Practice Address - Phone:207-210-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant