Individual
GENA E. LYELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
313 FEDERAL DR NW, SUITE 200, CORYDON, IN 47112-3070
(812) 738-4155
(812) 738-6104
Mailing address
PO BOX 455, CORYDON, IN 47112-0455
(823) 738-4155
(812) 738-6140
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4475P
KY
363LF0000X
Family Nurse Practitioner
Primary
71002361A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000616162
ANTHEM
IN
01
—
351920057
TAX IDENTIFICATION NUMBER
IN
Enumeration date
07/27/2006
Last updated
12/08/2020
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