Basic Information
| Provider Information | |||||||||
| NPI: | 1891332615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | NAKERA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11200 CHERRY HILL RD APT 201 | ||||||||
| Address2: | |||||||||
| City: | BELTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207053806 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11 HOPE RD STE 215 | ||||||||
| Address2: | |||||||||
| City: | STAFFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225547287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402251020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2019 | ||||||||
| LastUpdateDate: | 02/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 376J00000X | N | Nursing Service Related Providers | Homemaker | 106S00000X | RBT-20-119642 | MD | Y |
ID Information
| ID | Type | State | Issuer | Description | NEA101133 | 01 | MD | PHCS | OTHER |