Provider Demographics
NPI:1942524814
Name:BOYKIN, KATRINA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:BOYKIN
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 1:1319 GENESEE STREET
Mailing Address - Street 2:APT 1
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-4317
Mailing Address - Country:US
Mailing Address - Phone:315-601-0630
Mailing Address - Fax:
Practice Address - Street 1:1319 GENESEE ST
Practice Address - Street 2:APT 1
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4318
Practice Address - Country:US
Practice Address - Phone:315-601-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272023164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse