Individual
COLETTE BYRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSRT(R)(M)
Contact information
Practice address
3883 74TH AVE NE, FORT TOTTEN, ND 58335-0309
(701) 766-1629
Mailing address
PO BOX 309, FORT TOTTEN, ND 58335-0309
(701) 766-1600
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
—
—
2471M2300X
Mammography Radiologic Technologist
—
—
2471S1302X
Sonography Radiologic Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001061
—
ND
Enumeration date
12/27/2007
Last updated
12/27/2007
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