Tawana D Lyons

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

0018876 Issued in WI

Practice address

2332 Gilson St
Racine, WI 53403-3010

Phone

(262) 800-1032

NPI assigned

Feb 8, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1558068874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2332 GILSON ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534033010",
            "telephone_number": "262-287-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2332 GILSON ST",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534033010",
            "telephone_number": "262-800-1032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYONS",
        "first_name": "TAWANA",
        "middle_name": "D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-08",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": "0018876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS",
            "identifier": "PROV0002293446",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS",
            "identifier": "0002293446",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Ebner Luetzow, D.D.S.
• Julia M Luxner, PTA
• Luxottica of America Inc.
• Nora Lynch, OTR
• Jacquelyn R. Lyngdal, LCSW
• Marguerite Emily Macdonald, LPN
• Andrew Mach, P.T.A.
• Nancy Ruth Maczka, ADULT PMHNP
• Yvan Karlos Magana, LPC
• Cheryl A. Magner, N.P.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Racine, WI
• Providers in Racine, WI by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.