Healthcare Provider Details

I. General information

NPI: 1023135878
Provider Name (Legal Business Name): SEAN LYON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 NEWPORT RD STE 107
NEW LONDON NH
03257-5468
US

IV. Provider business mailing address

276 NEWPORT RD STE 107
NEW LONDON NH
03257-5468
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-4144
  • Fax: 603-526-4167
Mailing address:
  • Phone: 603-526-4144
  • Fax: 603-526-4167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number047202-23-03
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: