Provider Information for 1306048137
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Miss LISA LYON
Sex: Female
NPI: 1306048137
Last Updated: 2024-11-21
Certification Date: 2024-11-21
Certification Date: 2024-11-21
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1306048137 | ||||||||
| Enumeration Date | 2007-06-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 190 GEORGE WASHINGTON TPKE BURLINGTON, CT 06013-2415 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 190 GEORGE WASHINGTON TPKE BURLINGTON, CT 06013-2415 United States Phone: 860-748-3980 | Fax: | ||||||||
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