Healthcare Provider Details

I. General information

NPI: 1750560058
Provider Name (Legal Business Name): TAMMY L. LYONS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMY L. CLARK RN

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD MAILCODE 111E
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD MAILCODE 111E
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-3750
  • Fax:
Mailing address:
  • Phone: 310-268-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number443319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: