Individual
RENEE C LYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4401 BRIDGEPORT WAY W, UNIVERSITY PLACE, WA 98466-4201
(253) 564-4157
(253) 564-4813
Mailing address
4401 BRIDGEPORT WAY W, UNIVERSITY PLACE, WA 98466-4201
(253) 564-4157
(253) 564-4813
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00157089
WA
363LF0000X
Family Nurse Practitioner
Primary
AP30007419
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0213407
STATE L&I
WA
01
—
0222891
STATE L&I
WA
01
—
8943195
STATE CRIME VICTIMS
WA
01
—
8945094
STATE CRIME VICTIMS
WA
05
—
9650235
—
WA
Enumeration date
09/29/2006
Last updated
09/05/2014
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