Provider Demographics
NPI:1386180503
Name:LYONS, JEZNEE (AC60707200)
Entity Type:Individual
Prefix:
First Name:JEZNEE
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:AC60707200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7422 E GREEN LAKE DR N
Mailing Address - Street 2:APT #3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5382
Mailing Address - Country:US
Mailing Address - Phone:801-560-4034
Mailing Address - Fax:
Practice Address - Street 1:7422 E GREEN LAKE DR N
Practice Address - Street 2:APT #3
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5382
Practice Address - Country:US
Practice Address - Phone:801-560-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60707200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist