Individual
MARY BYRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1278 N LAFAYETTE DR, SUMTER, SC 29150-2964
(803) 774-4500
Mailing address
1278 N LAFAYETTE DR, SUMTER, SC 29150-2964
(803) 774-4500
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
91780
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7214
MEDICARE
SC
Enumeration date
04/27/2015
Last updated
04/27/2015
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