Healthcare Provider Details

I. General information

NPI: 1487172524
Provider Name (Legal Business Name): CORINNA MICHELLE EDWARDS LYON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORINNA MICHELLE EDWARDS

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WASHINGTON AVE STE 304
HAMDEN CT
06518-3273
US

IV. Provider business mailing address

60 WASHINGTON AVE STE 304
HAMDEN CT
06518-3273
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-2890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.008313
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: