Provider Demographics
NPI:1407149842
Name:BOAZ, ELIZABETH (LPN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BOAZ
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 1:1506 CORBIN DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2580
Mailing Address - Country:US
Mailing Address - Phone:513-310-4924
Mailing Address - Fax:
Practice Address - Street 1:1506 CORBIN DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2580
Practice Address - Country:US
Practice Address - Phone:513-310-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN123244164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse