Provider Demographics
NPI:1578932414
Name:BOYD, MICHAEL EUGENE (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:BOYD
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 JEFFERSON AVE
Mailing Address - Street 2:MCAULEY BLDG 4TH FL
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1038
Mailing Address - Country:US
Mailing Address - Phone:570-348-0360
Mailing Address - Fax:570-348-0362
Practice Address - Street 1:802 JEFFERSON AVE
Practice Address - Street 2:MCAULEY BLDG 4TH FL
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1038
Practice Address - Country:US
Practice Address - Phone:570-348-0360
Practice Address - Fax:570-348-0362
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily