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General NPI Number Information
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NPI Number | 1902245400
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Entity Type | Individual
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Provider Name | MARY T LYONS
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Gender | Female
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Dates
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Enumeration Date | 06/18/2013
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 9900 BREN RD E
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City | MINNETONKA
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State | MN
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Zip | 55343-9664
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Country | US
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Telephone | 443-844-5135
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Fax |
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Provider Business Mailing Address
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Address Line | 731 PHILLIPPA ST
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City | HINSDALE
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State | IL
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Zip | 60521-2444
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Country | US
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Telephone | 630-325-3706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209010448
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License Number State | IL
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