Provider Demographics
NPI:1801322243
Name:LYONS, DIANA MAE
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:MAE
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6882
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6882
Mailing Address - Country:US
Mailing Address - Phone:541-420-6150
Mailing Address - Fax:
Practice Address - Street 1:9020 S HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9666
Practice Address - Country:US
Practice Address - Phone:541-420-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver