Healthcare Provider Details

I. General information

NPI: 1659758852
Provider Name (Legal Business Name): MARY BYRD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 N LAFAYETTE DR
SUMTER SC
29150-2964
US

IV. Provider business mailing address

1278 N LAFAYETTE DR
SUMTER SC
29150-2964
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-4500
  • Fax:
Mailing address:
  • Phone: 803-774-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number91780
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: