Provider Demographics
NPI:1982636502
Name:LYONS, KATHLEEN (PA, RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LYONS
Suffix:
Gender:F
Credentials:PA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1209
Mailing Address - Country:US
Mailing Address - Phone:717-235-8117
Mailing Address - Fax:
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:EKG DEPARTMENT (BASEMENT)
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-6642
Practice Address - Fax:410-554-2333
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR092205163W00000X
MDC0001337363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q09604Medicare UPIN
000LH940Medicare ID - Type Unspecified