Individual
LYON TIGE HAZLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2951 FRONT ST, SUITE 3050, RICHLANDS, VA 24641-2055
(276) 963-8504
(276) 963-6642
Mailing address
2951 WEST FRONT STREET, SUITE 3050, RICHLANDS, VA 24641
(276) 963-8504
(276) 963-6642
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024166905
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
194170
ANTHEM BCBS
VA
05
—
38100005818
—
WV
01
—
P00318799
RAILROAD MEDICARE
VA
Enumeration date
08/31/2006
Last updated
07/09/2007
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