Provider Demographics
NPI:1568901858
Name:LYONS, CHRISTOPHER GABRIEL
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GABRIEL
Last Name:LYONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 NE 118TH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2158
Mailing Address - Country:US
Mailing Address - Phone:707-481-3294
Mailing Address - Fax:
Practice Address - Street 1:1343 NE 118 AVE. APT5
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:707-481-3294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion