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NPI Code Detail

MEDICARE: MS. NICOLE MARIE LYONS DNP, AGNP-C,PMHNP-BC

MEDICARE:  MS. NICOLE MARIE LYONS  DNP, AGNP-C,PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAP5672AZ
2363LA2200XAdult Health Nurse PractitionerAP5672AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093121600
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE MARIE LYONS DNP, AGNP-C,PMHNP-BC
Provider Business Mailing Address
First Line : 4981 S SOHO LN
Second Line :
City : CHANDLER
State : AZ
Zip : 85249-1820
Country : US
Telephone Number : 480-335-8838
Fax Number :
Provider Business Practice Location Address
First Line : 3271 E QUEEN CREEK RD STE 101
Second Line :
City : GILBERT
State : AZ
Zip : 85297-8511
Country : US
Telephone Number : 480-550-3193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2014
Last Update Date : 10/02/2024

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