MEDICARE: LAURIE LYONS NP

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
1	363LP2300X	Primary Care Nurse Practitioner	2024058337	NJ

General Provider Information

NPI Number	:	1396565040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE LYONS NP

Provider Business Mailing Address
First Line	:	1617 ROUTE 88 W
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3010
Country	:	US
Telephone Number	:	732-458-1903
Fax Number	:	732-458-1906

Provider Business Practice Location Address
First Line	:	1617 ROUTE 88 W
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3010
Country	:	US
Telephone Number	:	732-458-1903
Fax Number	:	732-458-1906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	01/14/2026

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