Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 272784-1205 | UT |
NPI | 1326013574 |
---|---|
Provider Name | Vicki J Lyons |
First Address | Ogden, UT 84403-3271 |
Second Address | Ogden, UT 84403-3271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 11/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F78291 | (02) | UT |
P00069425 | RAILROAD MEDICARE (01) | UT |