Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 420939 | NY |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 420939 | NY |
NPI | 1053641928 |
---|---|
Provider Name | Loren Deidre Lyons |
First Address | Westbury, NY 11590-5114 |
Second Address | Setauket, NY 11733-2036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2009 |
Last Update Date | 03/12/2019 |