Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | F400792 | NY |
NPI | 1013009620 |
---|---|
Provider Name | Lynda Lyon |
First Address | Saint James, NY 11780-1625 |
Second Address | Brentwood, NY 11717-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 12/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q62031 | (02) | NY |