Provider Demographics
NPI:1427564921
Name:BYRD, CHRISTINA (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:MENTZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:751 E GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:751 E GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2529
Practice Address - Country:US
Practice Address - Phone:313-922-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704377448163W00000X
MI4703111991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse