Provider Demographics
NPI:1225377138
Name:BOYD TOWBRIDGE, FELESHA ANN
Entity Type:Individual
Prefix:
First Name:FELESHA
Middle Name:ANN
Last Name:BOYD TOWBRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 AVONDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-8304
Mailing Address - Country:US
Mailing Address - Phone:419-242-5288
Mailing Address - Fax:
Practice Address - Street 1:616 AVONDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-8304
Practice Address - Country:US
Practice Address - Phone:419-242-5288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 122191164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse