=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447686316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH N TETTEH-LYONS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2013
-----------------------------------------------------
Last Update Date | 09/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 POND ST
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02067-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-784-6767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 POND ST
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02067-2037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN2260672
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------