Provider Demographics
NPI:1821112236
Name:BYARD, ELIZABETH DIANE (RNC FNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:BYARD
Suffix:
Gender:F
Credentials:RNC FNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:ELLSWORTH FAMILY PRACTICE
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-7770
Mailing Address - Fax:207-664-7723
Practice Address - Street 1:32 RESORT WAY
Practice Address - Street 2:ELLSWORTH FAMILY PRACTICE
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1717
Practice Address - Country:US
Practice Address - Phone:207-664-7770
Practice Address - Fax:207-664-7723
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERO24923363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME253000099Medicaid
MENP1292Medicare PIN
MES60702Medicare UPIN
MENP129202Medicare PIN
MENP129201Medicare PIN
MENP129203Medicare PIN