Provider Demographics
NPI:1225107048
Name:LYONS, MARQUITA PLESHETTE (CPNP)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:PLESHETTE
Last Name:LYONS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 STATION DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9247
Mailing Address - Country:US
Mailing Address - Phone:919-402-7216
Mailing Address - Fax:
Practice Address - Street 1:1708 TRAWICK RD
Practice Address - Street 2:SUITE 111
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-3897
Practice Address - Country:US
Practice Address - Phone:919-250-3478
Practice Address - Fax:919-250-6272
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-01540363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005932Medicaid