MEDICARE: MRS. TERESA LOUISE BYRD NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ00000500	NJ

General Provider Information

NPI Number	:	1194710079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA LOUISE BYRD NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	224 1ST AVE
Second Line	:
City	:	ESTELL MANOR
State	:	NJ
Zip	:	08319-1731
Country	:	US
Telephone Number	:	609-476-2883
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 E 6TH ST
Second Line	:
City	:	OCEAN CITY
State	:	NJ
Zip	:	08226-3826
Country	:	US
Telephone Number	:	609-399-1862
Fax Number	:	609-399-1572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	10/10/2007

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