Healthcare Provider Details

I. General information

NPI: 1477290799
Provider Name (Legal Business Name): CORI ANNE LYONS PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 04/17/2025
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL DIV PED HEMATOLOGY AND ONC
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6018
  • Fax: 844-621-4392
Mailing address:
  • Phone: 314-454-6018
  • Fax: 844-621-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022010796
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: