Provider Demographics
NPI:1023135878
Name:LYON, SEAN (APRN)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:LYON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 NEWPORT RD
Mailing Address - Street 2:STE 107
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5468
Mailing Address - Country:US
Mailing Address - Phone:603-526-4144
Mailing Address - Fax:603-526-4167
Practice Address - Street 1:276 NEWPORT RD
Practice Address - Street 2:STE 107
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5468
Practice Address - Country:US
Practice Address - Phone:603-526-4144
Practice Address - Fax:603-526-4167
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH047202-23-03363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH047202OtherLICENSE
NHNP325701Medicare PIN
NHS91174Medicare UPIN