Individual
DR. DWIGHT H LYSNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MDIV
Contact information
Practice address
20 S 16TH ST, WILMINGTON, NC 28401-4924
(877) 456-6729
(910) 399-3928
Mailing address
7212 OYSTER LN, WILMINGTON, NC 28411-7132
(910) 465-1935
(910) 399-3928
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
200301378
NC
2084P0804X
Child & Adolescent Psychiatry Physician
28290
MN
2084P0804X
Child & Adolescent Psychiatry Physician
5512
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15992
—
ND
01
—
19977
NDBCBS
ND
01
—
260045000
RAILROAD MEDICARE
—
05
—
891378J
—
NC
05
—
937078100
—
MN
01
—
94D78LY
MNBC/BS
MN
Enumeration date
04/20/2006
Last updated
09/26/2012
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