Basic Information
Provider Information
NPI: 1073169744
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYD
FirstName: LINDA
MiddleName: SUE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 56 COPLAND CIRCLE
Address2:  
City: VENTURA
State: CA
PostalCode: 93003
CountryCode: US
TelephoneNumber: 8052676927
FaxNumber:  
Practice Location
Address1: 2055 SAVIERS RD # 10
Address2:  
City: OXNARD
State: CA
PostalCode: 930333608
CountryCode: US
TelephoneNumber: 8054832253
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/17/2019
LastUpdateDate: 08/17/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164X00000XVN112677CAY Nursing Service ProvidersLicensed Vocational Nurse 

No ID Information.


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