Provider Demographics
NPI:1023024379
Name:BOIVIN, JANINE B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:B
Last Name:BOIVIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JANINE
Other - Middle Name:N
Other - Last Name:BISHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1262
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:12188A N MERIDIAN ST STE 200
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4410
Practice Address - Country:US
Practice Address - Phone:317-564-5100
Practice Address - Fax:317-564-5556
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000492A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN970019595OtherMEDICARE RAILROAD
IN1487680518OtherGROUP NPI
IN000000340608OtherANTHEM PIN NUMBER
IN318870PMedicare PIN
IN896480RMedicare PIN
IN970019595OtherMEDICARE RAILROAD
IN1487680518OtherGROUP NPI
IN069350MMedicare PIN
IN000000340608OtherANTHEM PIN NUMBER
IN677720RMedicare PIN