Provider Demographics
NPI:1003280934
Name:BOYLE, BRENDA JEAN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 EAST 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408
Mailing Address - Country:US
Mailing Address - Phone:909-382-7100
Mailing Address - Fax:
Practice Address - Street 1:1455 EAST 3RD STREET
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410
Practice Address - Country:US
Practice Address - Phone:909-382-7100
Practice Address - Fax:909-382-7103
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000991363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health