Provider Demographics
NPI:1669436689
Name:BOYNTON, LAWRENCE C (CFA)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:BOYNTON
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E DOUGLAS RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1464
Mailing Address - Country:US
Mailing Address - Phone:574-968-3516
Mailing Address - Fax:574-217-4824
Practice Address - Street 1:611 E DOUGLAS RD STE 108
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1464
Practice Address - Country:US
Practice Address - Phone:574-968-9100
Practice Address - Fax:574-217-4824
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27033142A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse