MEDICARE: RENEE C LYON ARNP

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	163W00000X	Registered Nurse	RN00157089	WA
2	363LF0000X	Family Nurse Practitioner	AP30007419	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0213407	OTHER	WA	STATE L&I
3	0222891	OTHER	WA	STATE L&I
4	8943195	OTHER	WA	STATE CRIME VICTIMS
5	8945094	OTHER	WA	STATE CRIME VICTIMS

General Provider Information

NPI Number	:	1922190651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE C LYON ARNP

Provider Business Mailing Address
First Line	:	4401 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4201
Country	:	US
Telephone Number	:	253-564-4157
Fax Number	:	253-564-4813

Provider Business Practice Location Address
First Line	:	4401 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4201
Country	:	US
Telephone Number	:	253-564-4157
Fax Number	:	253-564-4813

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	09/05/2014

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