Provider Demographics
NPI:1598940819
Name:LYONS, MARIANNE VERONICA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:VERONICA
Last Name:LYONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNC STUDENT HEALTH CASSIDY HALL
Mailing Address - Street 2:1901 10TH AVE
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80639-0001
Mailing Address - Country:US
Mailing Address - Phone:970-350-4934
Mailing Address - Fax:
Practice Address - Street 1:UNC STUDENT HEALTH CASSIDY HALL
Practice Address - Street 2:1901 10TH AVE
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-0001
Practice Address - Country:US
Practice Address - Phone:970-350-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-05
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG61385Medicare UPIN
COCO301499Medicare PIN