Provider Demographics
NPI:1528411915
Name:BOYD, MICHELLE MARIE (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:BOYD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:9 HIGHVIEW AVE
Mailing Address - City:TALLMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10982-0614
Mailing Address - Country:US
Mailing Address - Phone:845-357-0845
Mailing Address - Fax:
Practice Address - Street 1:9 HIGHVIEW AVE
Practice Address - Street 2:#614
Practice Address - City:TALLMAN
Practice Address - State:NY
Practice Address - Zip Code:10982
Practice Address - Country:US
Practice Address - Phone:845-357-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY419711-1163W00000X
NJ26NR10428000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse