Provider Demographics
NPI:1780613026
Name:BOYD, LISA B (LM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:BOYD
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-0283
Mailing Address - Country:US
Mailing Address - Phone:425-831-5123
Mailing Address - Fax:425-831-5123
Practice Address - Street 1:26405 NE VALLEY ST
Practice Address - Street 2:
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019-8499
Practice Address - Country:US
Practice Address - Phone:206-715-6123
Practice Address - Fax:425-788-3917
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW00000197175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7085681Medicaid