Healthcare Provider Details

I. General information

NPI: 1851017396
Provider Name (Legal Business Name): JESSICA MARIE BOYD III
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 WEST GREENLAWN AVE SUITE 200
LANSING MI
48910
US

IV. Provider business mailing address

405 WEST GREENLAWN AVE SUITE 200
LANSING MI
48910
US

V. Phone/Fax

Practice location:
  • Phone: 517-657-2638
  • Fax:
Mailing address:
  • Phone: 517-657-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: