Healthcare Provider Details

I. General information

NPI: 1780459123
Provider Name (Legal Business Name): STEPHANIE DAWN BOYD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/15/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N RANDALL RD STE 210
ELGIN IL
60123-7879
US

IV. Provider business mailing address

2509 E 950TH RD
CASEY IL
62420-3812
US

V. Phone/Fax

Practice location:
  • Phone: 224-760-7322
  • Fax:
Mailing address:
  • Phone: 217-218-4679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number209028738
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: