Basic Information
| Provider Information | |||||||||
| NPI: | 1972876746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BYERS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 N OXFORD AVE | ||||||||
| Address2: | BUILDING TWO | ||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547035184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158341078 | ||||||||
| FaxNumber: | 7158341274 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 N OXFORD AVE | ||||||||
| Address2: | BUILDING TWO | ||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547035184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158341078 | ||||||||
| FaxNumber: | 7158341274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2012 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | B620-4257-4242-08 | WI | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.