Active NPI
Mary T Lyons
- Family Nurse Practitioner
- Minnetonka, MN
National Provider Identifier
1902245400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209010448
- Practice address
- 9900 Bren Rd E
Minnetonka, MN 55343-9664 - Phone
- (443) 844-5135
- NPI assigned
- Jun 18, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209010448 | IL | Primary |
Addresses
Primary practice location
9900 Bren Rd E
Minnetonka, MN 55343-9664
Mailing address
731 Phillippa St
Hinsdale, IL 60521-2444
Phone (630) 325-3706
Other practice location 1
731 Phillippa St
Hinsdale, IL 60521-2444
Phone (630) 325-3706
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209010448 | IL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1371513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593129600000",
"number": "1902245400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "731 PHILLIPPA ST",
"city": "HINSDALE",
"state": "IL",
"postal_code": "605212444",
"telephone_number": "630-325-3706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9900 BREN RD E",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "553439664",
"telephone_number": "443-844-5135"
}
],
"practiceLocations": [
{
"address_1": "731 Phillippa St",
"address_purpose": "LOCATION",
"city": "Hinsdale",
"state": "IL",
"postal_code": "605212444",
"country_code": "US",
"telephone_number": "630-325-3706",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LYONS",
"first_name": "MARY",
"middle_name": "T",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-18",
"last_updated": "2020-06-26",
"certification_date": "2020-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209010448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.