Individual
JESSICA RAE LYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5301 MCAULEY DR, YPSILANTI, MI 48197-1051
(877) 336-6307
(734) 887-8979
Mailing address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 266-6800
(414) 337-7068
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301511319
MI
208000000X
Pediatrics Physician
75102
WI
2080N0001X
Neonatal-Perinatal Medicine Physician
75102
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205333077
—
WI
Enumeration date
04/09/2018
Last updated
10/07/2024
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