Provider Demographics
NPI:1093121600
Name:LYONS, NICOLE MARIE (DNP, AGNP-C,PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:LYONS
Suffix:
Gender:F
Credentials:DNP, AGNP-C,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4981 S SOHO LN
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-1820
Mailing Address - Country:US
Mailing Address - Phone:480-335-8838
Mailing Address - Fax:
Practice Address - Street 1:3271 E QUEEN CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8511
Practice Address - Country:US
Practice Address - Phone:480-550-3193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5672363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ929811Medicaid