Provider Demographics
NPI:1326761123
Name:BYERS, BRIANNA ANGELIQUE (LPN)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ANGELIQUE
Last Name:BYERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:ANGELIQUE
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 CORNWALL LN APT 2I
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1087
Mailing Address - Country:US
Mailing Address - Phone:347-475-4917
Mailing Address - Fax:
Practice Address - Street 1:3 CORNWALL LN APT 2I
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1087
Practice Address - Country:US
Practice Address - Phone:347-475-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341377-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse