MEDICARE: TARA MARIE 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	363LA2100X	Acute Care Nurse Practitioner	F430175-1	NY

General Provider Information

NPI Number	:	1730411885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MARIE LYONS NP

Provider Business Mailing Address
First Line	:	PO BOX 8503
Second Line	:
City	:	PELHAM
State	:	NY
Zip	:	10803-8503
Country	:	US
Telephone Number	:	917-226-9836
Fax Number	:	877-636-0628

Provider Business Practice Location Address
First Line	:	125 PARK DR
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10464-1005
Country	:	US
Telephone Number	:	917-226-9836
Fax Number	:	877-636-0628

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

Provider Enumeration Date	:	01/31/2010
Last Update Date	:	05/21/2013

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