Individual
TOMMY W. LYONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1250 S WASHINGTON ST, VAN WERT, OH 45891-2551
(419) 232-2866
(419) 232-2867
Mailing address
140 FOX RD, SUITE 207, VAN WERT, OH 45891-2475
(419) 232-2866
(419) 232-2867
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN271691
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
NA71515
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000373810
ANTHEM BC/BS
OH
01
—
202903724
MEDICAL MUTUAL
OH
01
—
20290372400
WORKMENS COMP
OH
05
—
2495250
—
OH
01
—
P00241523
MEDICARE RAILROAD INDV.
OH
Enumeration date
10/04/2005
Last updated
01/24/2020
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