Healthcare Provider Details

I. General information

NPI: 1912456765
Provider Name (Legal Business Name): ASHLEY LYONS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MYRTLE ST
MEDFORD OR
97504-7471
US

IV. Provider business mailing address

8725 JOHN DAY DR
GOLD HILL OR
97525-5524
US

V. Phone/Fax

Practice location:
  • Phone: 541-779-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number201507150RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: