Provider Demographics
NPI:1760792675
Name:LYONS-MCINERNEY, LORI (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:LYONS-MCINERNEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 BAYPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1849
Mailing Address - Country:US
Mailing Address - Phone:631-576-7104
Mailing Address - Fax:
Practice Address - Street 1:1633 SYCAMORE AVE STE 4
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1730
Practice Address - Country:US
Practice Address - Phone:631-576-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302832164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse