Provider Demographics
NPI:1578913877
Name:LYONS, LORI
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 NEWARK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9561
Mailing Address - Country:US
Mailing Address - Phone:740-392-4586
Mailing Address - Fax:740-392-4586
Practice Address - Street 1:5710 NEWARK RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9561
Practice Address - Country:US
Practice Address - Phone:740-392-4586
Practice Address - Fax:740-392-4586
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169181OtherODJFS MEDICAID PROVIDER NUMBER: