Provider Demographics
NPI:1073234092
Name:LYONS, JENNIFER E
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 MASTEN RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:14743-9710
Mailing Address - Country:US
Mailing Address - Phone:716-378-5858
Mailing Address - Fax:
Practice Address - Street 1:2178 N 5TH ST
Practice Address - Street 2:
Practice Address - City:ALLEGANY
Practice Address - State:NY
Practice Address - Zip Code:14706-1138
Practice Address - Country:US
Practice Address - Phone:716-373-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721156-01163W00000X
NYF349123-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse