Provider Demographics
NPI:1023657616
Name:LYLE, DANIEL (CPT, LFC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:LYLE
Suffix:
Gender:M
Credentials:CPT, LFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-7028
Mailing Address - Country:US
Mailing Address - Phone:402-618-2579
Mailing Address - Fax:
Practice Address - Street 1:2660 N 72ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-7028
Practice Address - Country:US
Practice Address - Phone:402-618-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE833993092OtherBLUE CROSS BLUE SHIELD
NE833993092Medicaid
NE833993092OtherHUMANA