Healthcare Provider Details

I. General information

NPI: 1043137235
Provider Name (Legal Business Name): CHERYL L LYON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 4TH AVE NE
DEVILS LAKE ND
58301-3020
US

IV. Provider business mailing address

202 4TH AVE NE
DEVILS LAKE ND
58301-3020
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-5061
  • Fax: 701-662-2412
Mailing address:
  • Phone: 701-662-5061
  • Fax: 701-662-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberLYO-66-6354
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: