Provider Demographics
NPI:1346430212
Name:LYONS, JODYLEE KATHARINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JODYLEE
Middle Name:KATHARINE
Last Name:LYONS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JODYLEE
Other - Middle Name:KATHARINE
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3570 42ND STREET SOUTH
Mailing Address - Street 2:#211
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104
Mailing Address - Country:US
Mailing Address - Phone:701-364-5614
Mailing Address - Fax:
Practice Address - Street 1:106 NORTH 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0613837164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse