Provider Demographics
NPI:1063631927
Name:BOYD, EDWARD B (CRNA)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:B
Last Name:BOYD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:96 15TH ST NW
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1620
Mailing Address - Country:US
Mailing Address - Phone:276-679-8890
Mailing Address - Fax:276-679-9740
Practice Address - Street 1:96 15TH ST NW
Practice Address - Street 2:SUITE 104
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1620
Practice Address - Country:US
Practice Address - Phone:276-679-8890
Practice Address - Fax:276-679-9740
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001190409163W00000X
VA0024167320367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063631927Medicaid
VA00X674N17Medicare PIN