Provider Demographics
NPI:1679146070
Name:BYRON, LISA ANN
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BYRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 HIGHWAY 32
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:ND
Mailing Address - Zip Code:58227-9620
Mailing Address - Country:US
Mailing Address - Phone:701-331-1224
Mailing Address - Fax:
Practice Address - Street 1:806 GRACE AVE.
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220
Practice Address - Country:US
Practice Address - Phone:701-265-4574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion