Provider Demographics
NPI:1730837790
Name:BOICE, TELIA RAEANN
Entity type:Individual
Prefix:
First Name:TELIA
Middle Name:RAEANN
Last Name:BOICE
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 1:619 NAPOLEON ST APT C
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2401
Mailing Address - Country:US
Mailing Address - Phone:419-307-8012
Mailing Address - Fax:
Practice Address - Street 1:215 S ELM ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:OH
Practice Address - Zip Code:43469-1319
Practice Address - Country:US
Practice Address - Phone:419-307-8012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker