Provider Demographics
NPI:1316466337
Name:BOYD, STEPHANIE LIZ-HERNANDEZ
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LIZ-HERNANDEZ
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:HERNANDEZZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3441 KNEIRIM DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2214
Mailing Address - Country:US
Mailing Address - Phone:440-522-5250
Mailing Address - Fax:
Practice Address - Street 1:3441 KNEIRIM DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2214
Practice Address - Country:US
Practice Address - Phone:440-522-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.158280.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse