Provider Demographics
NPI:1164817755
Name:BOYEA, MARTHA C (LPN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:BOYEA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 DULEY ROAD
Mailing Address - Street 2:
Mailing Address - City:ALTONA
Mailing Address - State:NY
Mailing Address - Zip Code:12910
Mailing Address - Country:US
Mailing Address - Phone:518-493-3437
Mailing Address - Fax:
Practice Address - Street 1:460 DULEY ROAD
Practice Address - Street 2:
Practice Address - City:ALTONA
Practice Address - State:NY
Practice Address - Zip Code:12910-1708
Practice Address - Country:US
Practice Address - Phone:518-493-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261532-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse