Provider Demographics
NPI:1508573528
Name:BYRD, ANETA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANETA
Middle Name:M
Last Name:BYRD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ANETA
Other - Middle Name:M
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:731 SABRINA DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-3582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:731 SABRINA DR UNIT C
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-3582
Practice Address - Country:US
Practice Address - Phone:309-699-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ280021164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse