Provider Demographics
NPI:1417670829
Name:BOYLE, DIANA NICOLE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:NICOLE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 VEGA DR
Mailing Address - Street 2:
Mailing Address - City:SHOREHAM
Mailing Address - State:NY
Mailing Address - Zip Code:11786-2306
Mailing Address - Country:US
Mailing Address - Phone:631-566-4373
Mailing Address - Fax:
Practice Address - Street 1:5 VEGA DR
Practice Address - Street 2:
Practice Address - City:SHOREHAM
Practice Address - State:NY
Practice Address - Zip Code:11786-2306
Practice Address - Country:US
Practice Address - Phone:631-566-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY780495163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical