Provider Demographics
NPI:1174779920
Name:BOYD, NICOLE MICHELLE (RN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MICHELLE
Last Name:BOYD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:MICHELLE
Other - Last Name:EXUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10084 RIDGESIDE CT
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-6610
Mailing Address - Country:US
Mailing Address - Phone:216-404-8305
Mailing Address - Fax:
Practice Address - Street 1:10084 RIDGESIDE CT
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-6610
Practice Address - Country:US
Practice Address - Phone:216-404-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 320355163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse