Healthcare Provider Details

I. General information

NPI: 1891975694
Provider Name (Legal Business Name): BILLIE WOOTEN LYONS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 ALBERT RD
BRANDYWINE MD
20613-3035
US

IV. Provider business mailing address

7450 ALBERT RD
BRANDYWINE MD
20613-3035
US

V. Phone/Fax

Practice location:
  • Phone: 301-888-2233
  • Fax: 301-833-9133
Mailing address:
  • Phone: 301-888-2233
  • Fax: 301-599-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168329
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: