Provider Demographics
NPI:1053499178
Name:LYONS, EDWARD (APRN,BC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 JOHN A CUMMINGS WAY
Mailing Address - Street 2:WELD BLDG
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3247
Mailing Address - Country:US
Mailing Address - Phone:401-235-7469
Mailing Address - Fax:401-767-4516
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:WELD BLDG
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-421-0060
Practice Address - Fax:401-421-6676
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN29610363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
007056003Medicare ID - Type Unspecified
Q01959Medicare UPIN