Healthcare Provider Details

I. General information

NPI: 1285157370
Provider Name (Legal Business Name): HEATHER KATE BYAM CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER KATE BYAM CRNA

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 06/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MILL ROAD
ROCHESTER NY
14626
US

IV. Provider business mailing address

280 MILL RD
ROCHESTER NY
14626-1038
US

V. Phone/Fax

Practice location:
  • Phone: 585-766-1512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number115831
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number603965
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: