Provider Demographics
NPI:1003108572
Name:BLAIR BOYKIN, ANGELA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:BLAIR BOYKIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BRITTIN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3419
Mailing Address - Country:US
Mailing Address - Phone:203-870-1751
Mailing Address - Fax:203-870-1751
Practice Address - Street 1:115 BRITTIN AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-3419
Practice Address - Country:US
Practice Address - Phone:203-870-1751
Practice Address - Fax:203-870-1751
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11.035623164W00000X
NY278790164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse