Healthcare Provider Details

I. General information

NPI: 1962083402
Provider Name (Legal Business Name): MAURA KELLY LYONS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAURA KELLY STOEHR

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9104 BABCOCK BLVD STE 3105
PITTSBURGH PA
15237-5818
US

IV. Provider business mailing address

615 GORMLEY AVE
CARNEGIE PA
15106-2815
US

V. Phone/Fax

Practice location:
  • Phone: 724-772-2664
  • Fax:
Mailing address:
  • Phone: 412-715-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN723012
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP028152
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: