Provider Demographics
NPI:1023737475
Name:BAYARD, MYRTHILLE (RN)
Entity type:Individual
Prefix:
First Name:MYRTHILLE
Middle Name:
Last Name:BAYARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FARMINGDALE ROAD, WEST BABYLON
Mailing Address - Street 2:
Mailing Address - City:N.Y
Mailing Address - State:NY
Mailing Address - Zip Code:11704
Mailing Address - Country:US
Mailing Address - Phone:631-669-5355
Mailing Address - Fax:
Practice Address - Street 1:1 FARMINGDALE ROAD, WEST BABYLON
Practice Address - Street 2:
Practice Address - City:N.Y
Practice Address - State:NY
Practice Address - Zip Code:11704
Practice Address - Country:US
Practice Address - Phone:631-669-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY813833163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRJU3HZN68479830OtherHORIZON BLUE CROSS BLUE SHIELD