Provider Demographics
NPI:1346686102
Name:BOYLE, AUDREY MARIA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:MARIA
Last Name:BOYLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:AUDREY
Other - Middle Name:MARIA
Other - Last Name:RUSKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:117 ELLENFIELD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-4513
Mailing Address - Country:US
Mailing Address - Phone:401-444-6779
Mailing Address - Fax:401-444-6912
Practice Address - Street 1:146 W RIVER ST
Practice Address - Street 2:SUITE 11D
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-793-5700
Practice Address - Fax:401-793-7801
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00516363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1346686102Medicaid
RI1346686102Medicaid