Provider Demographics
NPI:1497867444
Name:BOYLE, KATHRYN TERESE
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:TERESE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:TERESE
Other - Last Name:VANCLEAVE & SPICER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:525 S LAKE AVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2300
Mailing Address - Country:US
Mailing Address - Phone:218-740-2321
Mailing Address - Fax:
Practice Address - Street 1:525 S LAKE AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2300
Practice Address - Country:US
Practice Address - Phone:218-740-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 117361-9163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse