Healthcare Provider Details

I. General information

NPI: 1326258211
Provider Name (Legal Business Name): SUSAN LYONS R.N., I.B.C.L.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 N EDGEWOOD AVE
LA GRANGE PARK IL
60526-5508
US

IV. Provider business mailing address

426 N EDGEWOOD AVE
LA GRANGE PARK IL
60526-5508
US

V. Phone/Fax

Practice location:
  • Phone: 708-579-0086
  • Fax: 708-579-5598
Mailing address:
  • Phone: 708-579-0086
  • Fax: 708-579-5598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: