Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | ME101007 | FL |
NPI | 1285671628 |
---|---|
Provider Name | Ivy Boydstun |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000070000 | (05) | FL |
F88632 | (02) | NY |