Provider Demographics
NPI:1255355368
Name:LYONS, NOREEN E (APNP)
Entity type:Individual
Prefix:
First Name:NOREEN
Middle Name:E
Last Name:LYONS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 W RACINE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1053
Mailing Address - Country:US
Mailing Address - Phone:920-674-6000
Mailing Address - Fax:920-674-3034
Practice Address - Street 1:840 W RACINE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1053
Practice Address - Country:US
Practice Address - Phone:920-674-6000
Practice Address - Fax:920-674-3034
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1052-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43878000Medicaid
WI43878000Medicaid
S53554Medicare UPIN
WI43878000Medicaid