Provider Demographics
NPI:1619071032
Name:LYALL, BARBARA A (RNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:LYALL
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RIVER RD APT C
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3471
Mailing Address - Country:US
Mailing Address - Phone:718-920-7474
Mailing Address - Fax:718-515-8235
Practice Address - Street 1:MMC - DEPT. OF NEUROSURGERY
Practice Address - Street 2:3316 ROCHAMBEAU AVENUE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-2896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300959363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner