Healthcare Provider Details

I. General information

NPI: 1114019668
Provider Name (Legal Business Name): SHARON RUTH LYONS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

859 GLADDEN RD
COLUMBUS OH
43212-3812
US

V. Phone/Fax

Practice location:
  • Phone: 216-445-5253
  • Fax: 216-445-2806
Mailing address:
  • Phone: 614-291-8990
  • Fax: 614-486-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP08910
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: