Provider Demographics
NPI:1174657746
Name:LYONS, RACHEL L (APNP, FNP)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:L
Last Name:LYONS
Suffix:
Gender:F
Credentials:APNP, FNP
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:L
Other - Last Name:LUTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP, FNP
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:3925 W ELM ST
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-4361
Practice Address - Country:US
Practice Address - Phone:800-323-8622
Practice Address - Fax:224-225-0396
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3064363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
3006005233-22OtherFNP CERTIFICATION NUMBER
WI36027300Medicaid
WIQ76132Medicare UPIN
WI36027300Medicaid