Healthcare Provider Details

I. General information

NPI: 1003191727
Provider Name (Legal Business Name): PHYLLIS JANE LYONS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 LAKEWOOD DR
BELLEFONTAINE OH
43311-2800
US

IV. Provider business mailing address

118 LAKEWOOD DR
BELLEFONTAINE OH
43311-2800
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-3407
  • Fax:
Mailing address:
  • Phone: 937-599-3407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number106877
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number77459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: