Provider Demographics
NPI:1497842207
Name:BOYER, CAROL A (LMP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:BOYER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:A
Other - Last Name:BOYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP
Mailing Address - Street 1:219 E MAIN ST
Mailing Address - Street 2:BOX 733
Mailing Address - City:MOSSYROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98564-0733
Mailing Address - Country:US
Mailing Address - Phone:360-983-8770
Mailing Address - Fax:360-983-8770
Practice Address - Street 1:219 E MAIN ST
Practice Address - Street 2:219 E MAIN ST
Practice Address - City:MOSSYROCK
Practice Address - State:WA
Practice Address - Zip Code:98564
Practice Address - Country:US
Practice Address - Phone:360-983-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00007773174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00007773OtherLMP