Provider Demographics
NPI:1245239110
Name:BYERS, THOMASENE (CRNA)
Entity type:Individual
Prefix:MS
First Name:THOMASENE
Middle Name:
Last Name:BYERS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 WOOD HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9323
Mailing Address - Country:US
Mailing Address - Phone:734-856-2448
Mailing Address - Fax:734-856-2448
Practice Address - Street 1:4009 WOOD HAVEN CT
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9323
Practice Address - Country:US
Practice Address - Phone:734-856-2448
Practice Address - Fax:734-856-2448
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN129688367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0756150Medicaid
OHBY8232801Medicare ID - Type Unspecified
R54658Medicare UPIN