Healthcare Provider Details

I. General information

NPI: 1538385596
Provider Name (Legal Business Name): MARIANNE AGNES BYRON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S UNION BLVD
COLORADO SPRINGS CO
80910-3123
US

IV. Provider business mailing address

223 E FONTANERO ST
COLORADO SPRINGS CO
80907-7454
US

V. Phone/Fax

Practice location:
  • Phone: 719-578-3107
  • Fax: 719-578-3192
Mailing address:
  • Phone: 719-635-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number88484
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: