Healthcare Provider Details

I. General information

NPI: 1679146070
Provider Name (Legal Business Name): LISA ANN BYRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2021
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 GRACE AVE.
CAVALIER ND
58220
US

IV. Provider business mailing address

8455 HIGHWAY 32
EDINBURG ND
58227-9620
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-4574
  • Fax:
Mailing address:
  • Phone: 701-331-1224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: