Healthcare Provider Details

I. General information

NPI: 1013375161
Provider Name (Legal Business Name): MARK JAMES BOYD LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ERIN CT
HILLSBORO OH
45133-8591
US

IV. Provider business mailing address

104 ERIN CT
HILLSBORO OH
45133-8591
US

V. Phone/Fax

Practice location:
  • Phone: 937-393-4562
  • Fax: 937-393-2056
Mailing address:
  • Phone: 937-393-4562
  • Fax: 937-393-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN103666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: