Provider Demographics
NPI:1508651548
Name:SPAIN, LYRIC NICOLE (LPN)
Entity type:Individual
Prefix:
First Name:LYRIC
Middle Name:NICOLE
Last Name:SPAIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06607-1832
Mailing Address - Country:US
Mailing Address - Phone:203-808-0462
Mailing Address - Fax:
Practice Address - Street 1:285 ORANGE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06607-1832
Practice Address - Country:US
Practice Address - Phone:203-808-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46577164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse