Healthcare Provider Details

I. General information

NPI: 1386838944
Provider Name (Legal Business Name): ELIZABETH ANN BYROM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH ANN FULLOM RN

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 08/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

IV. Provider business mailing address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-6621
  • Fax:
Mailing address:
  • Phone: 717-272-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN522214L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: