Healthcare Provider Details

I. General information

NPI: 1902536741
Provider Name (Legal Business Name): SHEILA O LYONS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3091 NE 57TH AVE APT C
VANCOUVER WA
98661-6756
US

IV. Provider business mailing address

3091 NE 57TH AVE APT C
VANCOUVER WA
98661-6756
US

V. Phone/Fax

Practice location:
  • Phone: 971-352-9247
  • Fax:
Mailing address:
  • Phone: 971-352-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61308485
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: