Provider Demographics
NPI:1467833699
Name:BOYLE DONOVAN, COLLEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:BOYLE DONOVAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BANNOCKBURN AVE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-5806
Mailing Address - Country:US
Mailing Address - Phone:215-378-2880
Mailing Address - Fax:215-481-4070
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:CHIEF OF STAFF OFFICE
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-2919
Practice Address - Fax:215-481-4070
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily