Provider Demographics
NPI:1811363096
Name:LYON, THELMA (RN)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:THELMA
Other - Middle Name:
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:634 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3308
Mailing Address - Country:US
Mailing Address - Phone:917-743-3103
Mailing Address - Fax:
Practice Address - Street 1:634 E 78 ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236
Practice Address - Country:US
Practice Address - Phone:917-743-3103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY360151163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse