Provider Demographics
NPI:1982001905
Name:LYONS, ANDREW HALE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:HALE
Last Name:LYONS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 S I-19 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-1254
Mailing Address - Country:US
Mailing Address - Phone:520-393-4486
Mailing Address - Fax:833-485-4196
Practice Address - Street 1:4475 S. I-19 FRONTAGE RD, SUITE 255
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1254
Practice Address - Country:US
Practice Address - Phone:520-393-4863
Practice Address - Fax:833-485-4196
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN166025163W00000X
AZAP7433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse