Provider Demographics
NPI:1245428705
Name:LYONS, LEONARD WAYNE (MA)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:WAYNE
Last Name:LYONS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-4598
Mailing Address - Country:US
Mailing Address - Phone:541-966-7789
Mailing Address - Fax:
Practice Address - Street 1:622 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-4598
Practice Address - Country:US
Practice Address - Phone:541-966-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program