MEDICARE: LAURA MARIE LYONS APRN

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	363LF0000X	Family Nurse Practitioner	53-76063-111	KS

General Provider Information

NPI Number	:	1801221486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE LYONS APRN

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-7148
Country	:	US
Telephone Number	:	913-588-6140
Fax Number	:

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-7148
Country	:	US
Telephone Number	:	913-588-6140
Fax Number	:

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

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	09/13/2013

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