Healthcare Provider Details

I. General information

NPI: 1023445459
Provider Name (Legal Business Name): MICKI DAHNE LYONS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 W. OAK STREET
SUNDANCE WY
82729
US

IV. Provider business mailing address

6614 BANDON LN
RAPID CITY SD
57702-9457
US

V. Phone/Fax

Practice location:
  • Phone: 307-283-2476
  • Fax: 307-283-2489
Mailing address:
  • Phone: 307-680-5615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19660.1267
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: