Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 62252 | MN |
Y | 208200000X | Surgeon | 62252 | MN |
Y | 208600000X | Surgeon | 62252 | MN |
NPI | 1013336106 |
---|---|
Provider Name | Nicole Lyons |
First Address | Bloomington, MN 55425-4516 |
Second Address | Saint Paul, MN 55101-2502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 17/03/2018 |