Healthcare Provider Details

I. General information

NPI: 1134441702
Provider Name (Legal Business Name): LYRON ANDRE DEPUTY CNS,FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 CHAPMAN RD STE 100
NEWARK DE
19702-5426
US

IV. Provider business mailing address

261 CHAPMAN RD STE 100
NEWARK DE
19702-5426
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-5109
  • Fax: 877-575-3337
Mailing address:
  • Phone: 302-652-5109
  • Fax: 877-575-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0001219
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: