Provider Demographics
NPI:1487172524
Name:LYON, CORINNA MICHELLE EDWARDS (APRN)
Entity type:Individual
Prefix:
First Name:CORINNA
Middle Name:MICHELLE EDWARDS
Last Name:LYON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CORINNA
Other - Middle Name:MICHELLE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 WASHINGTON AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3273
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 WASHINGTON AVE STE 304
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3273
Practice Address - Country:US
Practice Address - Phone:203-281-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.008313363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health