Provider Demographics
NPI:1235531120
Name:BOYER, ASHLEY ERIN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ERIN
Last Name:BOYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:179 SHINNECOCK HL
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19311-1429
Mailing Address - Country:US
Mailing Address - Phone:610-766-0397
Mailing Address - Fax:
Practice Address - Street 1:179 SHINNECOCK HL
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-1429
Practice Address - Country:US
Practice Address - Phone:610-766-0397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN008333133V00000X
DEDN-0000531133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD084143900Medicaid