Healthcare Provider Details

I. General information

NPI: 1750751327
Provider Name (Legal Business Name): JEFFREY LYONS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 STALLWORTH CT
ELSMERE KY
41018-1959
US

IV. Provider business mailing address

390 STALLWORTH CT
ELSMERE KY
41018-1959
US

V. Phone/Fax

Practice location:
  • Phone: 859-462-7189
  • Fax:
Mailing address:
  • Phone: 859-462-7189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number337035
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: