Basic Information
| Provider Information | |||||||||
| NPI: | 1952945842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BYARS BILES | ||||||||
| FirstName: | LASHAY | ||||||||
| MiddleName: | DONNETTA | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25639 FORD RD. | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132773293 | ||||||||
| FaxNumber: | 3132770917 | ||||||||
| Practice Location | |||||||||
| Address1: | 25639 FORD RD. | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132773293 | ||||||||
| FaxNumber: | 3132770917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2019 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 4703104235 | MI | Y | Nursing Service Providers | Licensed Practical Nurse |
ID Information
| ID | Type | State | Issuer | Description | 4703104235 | 01 | MI | LICENSED PRACTICAL NURSE LICENSE NUMBER | OTHER |