Provider Demographics
NPI:1225818339
Name:BOYD, QURISHA MONIQUE
Entity Type:Individual
Prefix:
First Name:QURISHA
Middle Name:MONIQUE
Last Name:BOYD
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 1:2411 SPRINGDALE RD APT 5B
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2760
Mailing Address - Country:US
Mailing Address - Phone:262-888-2305
Mailing Address - Fax:
Practice Address - Street 1:2411 SPRINGDALE RD APT 5B
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2760
Practice Address - Country:US
Practice Address - Phone:262-888-2305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI343900000207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services