Provider Demographics
NPI:1184737512
Name:LYONNAIS, ANDREA M (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:LYONNAIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:COUEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:89 LEWIS BAY RD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5240
Mailing Address - Country:US
Mailing Address - Phone:508-418-6600
Mailing Address - Fax:508-796-2177
Practice Address - Street 1:89 LEWIS BAY RD UNIT 4
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5240
Practice Address - Country:US
Practice Address - Phone:508-418-6600
Practice Address - Fax:508-796-2177
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA1744363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0PA173480Medicare ID - Type Unspecified
Q18550Medicare UPIN