Provider Demographics
NPI:1952419772
Name:LYONS, COLLEEN CARALYN (MD)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CARALYN
Last Name:LYONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 WATERLOO LN # 101
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5587
Mailing Address - Country:US
Mailing Address - Phone:775-782-8265
Mailing Address - Fax:775-783-4487
Practice Address - Street 1:1330 WATERLOO LN # 101
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5587
Practice Address - Country:US
Practice Address - Phone:775-782-8265
Practice Address - Fax:775-783-4487
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG63394OtherCA MEDICAL LICENSE #
NV002013132Medicaid
NV5694OtherNV LICENSE #
NV003113132Medicaid
NV003113132Medicaid