Basic Information
| Provider Information | |||||||||
| NPI: | 1043462690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYON | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | LYNETTE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NURSE PRACTITIONER | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LYON | ||||||||
| OtherFirstName: | LYNETTE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10440 BLACK MOUNTAIN RD. | ||||||||
| Address2: | SAN DIEGO MIRAMAR COLLEGE, STUDENT HEALTH SERVICES S103 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585367881 | ||||||||
| FaxNumber: | 8586890387 | ||||||||
| Practice Location | |||||||||
| Address1: | 10440 BLACK MOUNTAIN RD | ||||||||
| Address2: | SAN DIEGO MIRAMAR COLLEGE STUDENT HEALTH SERVICES S-103 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585367881 | ||||||||
| FaxNumber: | 8586890387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2008 | ||||||||
| LastUpdateDate: | 10/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 11463 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 403159 | CA | N | Nursing Service Providers | Registered Nurse |
No ID Information.