Provider Demographics
NPI:1619200805
Name:LYONS, LYNETTE ANEITA (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:ANEITA
Last Name:LYONS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11408 200TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2809
Mailing Address - Country:US
Mailing Address - Phone:718-464-6353
Mailing Address - Fax:718-464-6353
Practice Address - Street 1:11408 200TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2809
Practice Address - Country:US
Practice Address - Phone:718-464-6353
Practice Address - Fax:718-464-6353
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-07
Last Update Date:2009-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560444-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse