Provider Demographics
NPI:1316398019
Name:LYON, MOLLIE LEWIS
Entity Type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:LEWIS
Last Name:LYON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:LEWIS
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, LPN
Mailing Address - Street 1:1919 PARKVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-1578
Mailing Address - Country:US
Mailing Address - Phone:724-652-5144
Mailing Address - Fax:724-856-8973
Practice Address - Street 1:1919 PARKVIEW BLVD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-1578
Practice Address - Country:US
Practice Address - Phone:724-652-5144
Practice Address - Fax:724-856-8973
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN254774L164W00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse