=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750161857
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSA D BOYD APRN, CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2023
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4309 W MEDICAL CENTER DR STE B301
-----------------------------------------------------
City | MCHENRY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60050-8439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-535-6083
-----------------------------------------------------
Fax | 847-234-4336
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4309 W MEDICAL CENTER DR STE B301
-----------------------------------------------------
City | MCHENRY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60050-8439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-535-6083
-----------------------------------------------------
Fax | 847-234-4336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 14595-033
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 209031131
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------