Provider Demographics
NPI:1235527474
Name:BIRUN, LYZETTE
Entity Type:Individual
Prefix:
First Name:LYZETTE
Middle Name:
Last Name:BIRUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LYZETTE
Other - Middle Name:N/A
Other - Last Name:BIRUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9879 GOOD LUCK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3233
Mailing Address - Country:US
Mailing Address - Phone:322-301-9268
Mailing Address - Fax:
Practice Address - Street 1:9879 GOOD LUCK RD APT 3
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3233
Practice Address - Country:US
Practice Address - Phone:322-301-9268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA2986374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDHHA2986OtherHOME HEALTH AIDE