MEDICARE: MS. VIRGINIA R. BOYD LPN/IV TECH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LP00032995	WA

General Provider Information

NPI Number	:	1326325283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIRGINIA R. BOYD LPN/IV TECH

Provider Business Mailing Address
First Line	:	PO BOX 175
Second Line	:
City	:	POMEROY
State	:	WA
Zip	:	99347-0175
Country	:	US
Telephone Number	:	509-843-1267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1238 ARLINGTON
Second Line	:
City	:	POMEROY
State	:	WA
Zip	:	99347-0175
Country	:	US
Telephone Number	:	509-843-1267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	11/07/2011

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