Provider Demographics
NPI:1376312801
Name:BYKER, AUDREY RENEE (NANP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:RENEE
Last Name:BYKER
Suffix:
Gender:F
Credentials:NANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1529 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-8358
Mailing Address - Country:US
Mailing Address - Phone:616-566-1086
Mailing Address - Fax:
Practice Address - Street 1:348 S WAVERLY RD STE 103
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-8101
Practice Address - Country:US
Practice Address - Phone:616-929-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4690133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist