Provider Demographics
NPI:1679362305
Name:LYONS, KAELA MARIE
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:MARIE
Last Name:LYONS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-1313
Mailing Address - Country:US
Mailing Address - Phone:440-344-5076
Mailing Address - Fax:
Practice Address - Street 1:748 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-9767
Practice Address - Country:US
Practice Address - Phone:440-344-5076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide