=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427699495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE BOYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2019
-----------------------------------------------------
Last Update Date | 10/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 149 W 22ND ST
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16502-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-384-0168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10229 JONES RD
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16510-5325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-384-0168
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | SP020900
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------