Provider Demographics
NPI:1356328124
Name:BOYD, LAURIE (NP)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 W MICHIGAN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236-8702
Mailing Address - Country:US
Mailing Address - Phone:517-456-4171
Mailing Address - Fax:517-456-4600
Practice Address - Street 1:1671 W MICHIGAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236-8702
Practice Address - Country:US
Practice Address - Phone:517-456-4171
Practice Address - Fax:517-456-4600
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47042112837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008756650OtherBCBS
MI000000379335OtherANTHEM
MI4794273Medicaid
MI4794273Medicaid
MIM35150038Medicare PIN