Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN265190 | MA |
NPI | 1003218041 |
---|---|
Provider Name | Patrick Lyons |
First Address | Norton, MA 02766-2738 |
Second Address | Norton, MA 02766-2738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2014 |
Last Update Date | 22/09/2014 |