Provider Demographics
NPI:1891084505
Name:LONEY, LYS A (RN)
Entity type:Individual
Prefix:MRS
First Name:LYS
Middle Name:A
Last Name:LONEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3525 TRIELOFF RD
Mailing Address - Street 2:LOT #27
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-8813
Mailing Address - Country:US
Mailing Address - Phone:608-723-9302
Mailing Address - Fax:
Practice Address - Street 1:N3525 TRIELOFF RD
Practice Address - Street 2:LOT #27
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-8813
Practice Address - Country:US
Practice Address - Phone:608-723-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI136006-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse