Provider Demographics
NPI:1295234292
Name:LYON, NICOLE R (RD, CD, RYT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:LYON
Suffix:
Gender:F
Credentials:RD, CD, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 EVANSTON AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7206
Mailing Address - Country:US
Mailing Address - Phone:206-414-8762
Mailing Address - Fax:833-291-4245
Practice Address - Street 1:4239 EVANSTON AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7206
Practice Address - Country:US
Practice Address - Phone:206-414-8762
Practice Address - Fax:833-291-4245
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered