Provider Demographics
NPI:1356937379
Name:BOYD, EOWYN ELISE (NP)
Entity type:Individual
Prefix:
First Name:EOWYN
Middle Name:ELISE
Last Name:BOYD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 FORD PL STE 3A
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3450
Mailing Address - Country:US
Mailing Address - Phone:313-874-4806
Mailing Address - Fax:313-876-1305
Practice Address - Street 1:1325 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1721
Practice Address - Country:US
Practice Address - Phone:517-273-3210
Practice Address - Fax:734-418-9068
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2024-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704255458363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner