Provider Demographics
NPI:1770853970
Name:BOYD-MATIC, HEIDI MAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MAY
Last Name:BOYD-MATIC
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 1:4285 BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3403
Mailing Address - Country:US
Mailing Address - Phone:717-817-5633
Mailing Address - Fax:
Practice Address - Street 1:6864 SUSQUEHANNA TRL S
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-9320
Practice Address - Country:US
Practice Address - Phone:717-428-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN276147164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse