Healthcare Provider Details

I. General information

NPI: 1013413962
Provider Name (Legal Business Name): CAROLANNE LYONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 S GRAND BLVD
SPOKANE WA
99203-5001
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-8220
  • Fax: 509-455-9172
Mailing address:
  • Phone: 866-747-2455
  • Fax: 509-227-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP61156889
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: