Provider Demographics
NPI:1073582375
Name:BOYLE, JENNIFER RENAUD (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENAUD
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:RENAUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 E 1ST ST
Mailing Address - Street 2:STE LL
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-5629
Mailing Address - Fax:218-722-5148
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:STE LL
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-5629
Practice Address - Fax:218-722-5148
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43560174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34705600Medicaid
ME191633500Medicaid
H33512Medicare UPIN
H33512Medicare UPIN