Provider Demographics
NPI:1316027881
Name:LYONS, MARY MELANIE (CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MELANIE
Last Name:LYONS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MELANIE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:700 ACKERMAN RD STE 570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-293-4925
Mailing Address - Fax:
Practice Address - Street 1:460 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-4925
Practice Address - Fax:614-293-5503
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008662363L00000X
OHAPRNCNP021816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ43545Medicare UPIN
PA090883H42Medicare ID - Type Unspecified