Provider Demographics
NPI:1902027402
Name:STEVENSON-LYON, NANCY LYNN (ATC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:STEVENSON-LYON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DERBY LINE
Mailing Address - State:VT
Mailing Address - Zip Code:05830-8934
Mailing Address - Country:US
Mailing Address - Phone:802-895-4379
Mailing Address - Fax:
Practice Address - Street 1:209 VETERANS AVE.
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855
Practice Address - Country:US
Practice Address - Phone:802-334-7921
Practice Address - Fax:802-334-1618
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00000112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer