Provider Demographics
NPI:1508341165
Name:BOYNTON, CAROLYN JOAN (RN SCHOOL)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOAN
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:RN SCHOOL
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:JOAN
Other - Last Name:GRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4355 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1010
Mailing Address - Country:US
Mailing Address - Phone:402-554-8644
Mailing Address - Fax:402-554-8638
Practice Address - Street 1:4355 CHARLES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-1010
Practice Address - Country:US
Practice Address - Phone:402-554-8644
Practice Address - Fax:402-554-8638
Is Sole Proprietor?:No
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49644163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool