Provider Demographics
NPI:1225485360
Name:BYRD, EKHOVBIYE
Entity Type:Individual
Prefix:
First Name:EKHOVBIYE
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2900
Mailing Address - Country:US
Mailing Address - Phone:617-283-2866
Mailing Address - Fax:978-498-4364
Practice Address - Street 1:10 JEFFERSON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2900
Practice Address - Country:US
Practice Address - Phone:617-283-2866
Practice Address - Fax:978-498-4364
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163W00000X163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse