Healthcare Provider Details

I. General information

NPI: 1780613026
Provider Name (Legal Business Name): LISA B BOYD L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26405 NE VALLEY ST
DUVALL WA
98019-8499
US

IV. Provider business mailing address

PO BOX 283
SNOQUALMIE WA
98065-0283
US

V. Phone/Fax

Practice location:
  • Phone: 206-715-6123
  • Fax: 425-788-3917
Mailing address:
  • Phone: 425-831-5123
  • Fax: 425-831-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMW00000197
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: