1306972153 NPI number — MRS. CHRISTINE LYNN BYRD LMP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306972153 NPI number — MRS. CHRISTINE LYNN BYRD LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BYRD
Provider First Name:
CHRISTINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DARLING
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306972153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17066 BEATON RD SE
Provider Second Line Business Mailing Address:
SUITE 170
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98272-1002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-863-0960
Provider Business Mailing Address Fax Number:
360-863-8710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17066 BEATON RD SE
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98272-1002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-863-0960
Provider Business Practice Location Address Fax Number:
360-863-8710
Provider Enumeration Date:
02/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA00023784 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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