Provider Demographics
NPI:1215142187
Name:BOYCE, LORA JANE
Entity type:Individual
Prefix:MS
First Name:LORA
Middle Name:JANE
Last Name:BOYCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 YALE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-1602
Mailing Address - Country:US
Mailing Address - Phone:330-209-9630
Mailing Address - Fax:
Practice Address - Street 1:1635 YALE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-1602
Practice Address - Country:US
Practice Address - Phone:330-209-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2248517Medicaid