Provider Demographics
NPI:1003846460
Name:BOYLE, DENISE R (MSN-BCFNP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:R
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MSN-BCFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 CANTON CENTER ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2694
Mailing Address - Country:US
Mailing Address - Phone:734-459-7444
Mailing Address - Fax:734-459-7755
Practice Address - Street 1:6231 CANTON CENTER ROAD
Practice Address - Street 2:STE 101
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2694
Practice Address - Country:US
Practice Address - Phone:734-459-7444
Practice Address - Fax:734-459-7755
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704145525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4871120Medicaid