=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316459357
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERNITA DANICA BOYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2017
-----------------------------------------------------
Last Update Date | 07/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 436 THEATER RD
-----------------------------------------------------
City | SOUTH HILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-444-3106
-----------------------------------------------------
Fax | 434-757-2218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 436 THEATER RD
-----------------------------------------------------
City | SOUTH HILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23970-5024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-233-7718
-----------------------------------------------------
Fax | 434-757-2218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171WV0202X
-----------------------------------------------------
Taxonomy Name | Vehicle Modifications Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------