Provider Demographics
NPI:1295079069
Name:BYRD, THERESE MARIE (STNA)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:BYRD
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BAKER AVENUE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45217
Mailing Address - Country:US
Mailing Address - Phone:513-242-3152
Mailing Address - Fax:
Practice Address - Street 1:40 BAKER AVENUE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45217
Practice Address - Country:US
Practice Address - Phone:513-242-3152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401030390110374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide