Provider Demographics
NPI:1942673298
Name:BOYD, ANGELICA
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27695 TRACY RD
Mailing Address - Street 2:300
Mailing Address - City:WALBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43465-9781
Mailing Address - Country:US
Mailing Address - Phone:419-377-8917
Mailing Address - Fax:
Practice Address - Street 1:27695 TRACY RD
Practice Address - Street 2:300
Practice Address - City:WALBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43465-9781
Practice Address - Country:US
Practice Address - Phone:419-377-8917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401751070515376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide