Provider Demographics
NPI:1871220186
Name:LYONS, NATHANAEL (RN)
Entity type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 NE FARGO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2141
Mailing Address - Country:US
Mailing Address - Phone:971-271-4145
Mailing Address - Fax:
Practice Address - Street 1:1120 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2828
Practice Address - Country:US
Practice Address - Phone:503-988-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201241794RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health