Individual
JESSICA A LYONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11751 NOTTINGHAM RD, DETROIT, MI 48224-4100
(313) 208-3219
Mailing address
11751 NOTTINGHAM RD, DETROIT, MI 48224-4100
(313) 208-3219
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
173C00000X
Reflexologist
—
—
174200000X
Meals Provider
—
—
251E00000X
Home Health Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
251T00000X
PACE Provider Organization
—
—
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
372500000X
Chore Provider
Primary
—
—
372600000X
Adult Companion
—
—
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
—
—
376K00000X
Nurse's Aide
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
372500000X
CHORE PROVIDER
—
05
—
815059937
—
MI
Enumeration date
07/25/2018
Last updated
05/31/2019
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