Provider Demographics
NPI:1528738812
Name:BOYD, DABREENDA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:DABREENDA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LODEWYCK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2233
Mailing Address - Country:US
Mailing Address - Phone:313-658-0007
Mailing Address - Fax:
Practice Address - Street 1:125 LODEWYCK ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2233
Practice Address - Country:US
Practice Address - Phone:313-658-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304001163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty