Provider Demographics
NPI:1023445459
Name:LYONS, MICKI DAHNE (NP-C)
Entity type:Individual
Prefix:
First Name:MICKI
Middle Name:DAHNE
Last Name:LYONS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 BANDON LN
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9457
Mailing Address - Country:US
Mailing Address - Phone:307-680-5615
Mailing Address - Fax:
Practice Address - Street 1:713 W. OAK STREET
Practice Address - Street 2:
Practice Address - City:SUNDANCE
Practice Address - State:WY
Practice Address - Zip Code:82729
Practice Address - Country:US
Practice Address - Phone:307-283-2476
Practice Address - Fax:307-283-2489
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY19660.1267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily