Provider Demographics
NPI:1134323017
Name:BOYLSTON, MARIANNE (RN, MSN, APN-C)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:BOYLSTON
Suffix:
Gender:F
Credentials:RN, MSN, APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4344
Mailing Address - Country:US
Mailing Address - Phone:732-238-6289
Mailing Address - Fax:
Practice Address - Street 1:65 JAMES STREET
Practice Address - Street 2:JFK JOHNSON REHABILITATION INSTITUTE
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08818
Practice Address - Country:US
Practice Address - Phone:908-578-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00006100363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0055832Medicaid
NJ089387CBHMedicare PIN