Provider Demographics
NPI:1982275871
Name:BYRON, MARIE-REINE GRACITA (APRN)
Entity Type:Individual
Prefix:DR
First Name:MARIE-REINE
Middle Name:GRACITA
Last Name:BYRON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:DR
Other - First Name:MARIEREINE
Other - Middle Name:GRACITA
Other - Last Name:PHANORD-BYRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:41 QUAKER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-2624
Mailing Address - Country:US
Mailing Address - Phone:203-913-8401
Mailing Address - Fax:
Practice Address - Street 1:687 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3774
Practice Address - Country:US
Practice Address - Phone:203-932-6481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily