Healthcare Provider Details

I. General information

NPI: 1508269416
Provider Name (Legal Business Name): DIANE LYONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 CREEKSIDE LOOP STE 100
YAKIMA WA
98902-4875
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 509-453-8600
  • Fax: 509-453-8616
Mailing address:
  • Phone: 630-303-5380
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA60496029
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: