Provider Demographics
NPI:1861676728
Name:BYRUM, COLETTE (BSRT(R)(M))
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:BYRUM
Suffix:
Gender:F
Credentials:BSRT(R)(M)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:FORT TOTTEN
Mailing Address - State:ND
Mailing Address - Zip Code:58335-0309
Mailing Address - Country:US
Mailing Address - Phone:701-766-1600
Mailing Address - Fax:
Practice Address - Street 1:3883 74TH AVE NE
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:ND
Practice Address - Zip Code:58335-0309
Practice Address - Country:US
Practice Address - Phone:701-766-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND001061Medicaid
NDHSZ056Medicare PIN