Provider Demographics
NPI:1093121600
Name:LYONS, NICOLE MARIE (DNP, RN, AGNP-BC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:LYONS
Suffix:
Gender:F
Credentials:DNP, RN, AGNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:11365 E STEARN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-7071
Mailing Address - Country:US
Mailing Address - Phone:440-391-8077
Mailing Address - Fax:
Practice Address - Street 1:2700 N 3RD ST
Practice Address - Street 2:STE 3045
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1129
Practice Address - Country:US
Practice Address - Phone:602-374-7522
Practice Address - Fax:602-327-6997
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5672363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ929811Medicaid