Basic Information
Provider Information
NPI: 1841689585
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BYINGTON
FirstName: NANCY
MiddleName: LOUISE
NamePrefix: MS.
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1239
Address2:  
City: TROY
State: MI
PostalCode: 480991239
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4444 W BRISTOL RD
Address2: STE 150
City: FLINT
State: MI
PostalCode: 485073153
CountryCode: US
TelephoneNumber: 8102309500
FaxNumber: 8102300169
Other Information
ProviderEnumerationDate: 01/19/2015
LastUpdateDate: 02/06/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X4704185413MIN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LF0000X4704185413MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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