Individual
SHAUNNA M LYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
(262) 245-2248
Mailing address
N2950 STATE ROAD 67, LAKE GENEVA, WI 53147-2655
(262) 245-0535
(262) 245-2248
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
37206
IA
208000000X
Pediatrics Physician
Primary
55298-20
WI
208000000X
Pediatrics Physician
R-7249
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891904546
—
WI
01
—
54309
WELLMARK BCBS
IA
01
—
LYONSHA
MERCYCARE INSURANCE
WI
Enumeration date
05/21/2007
Last updated
12/19/2012
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