Provider Demographics
NPI:1508802802
Name:BOYLE, JENNIFER M (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BOYLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6819
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-0297
Mailing Address - Country:US
Mailing Address - Phone:541-469-5377
Mailing Address - Fax:541-469-8015
Practice Address - Street 1:585 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9702
Practice Address - Country:US
Practice Address - Phone:541-469-5377
Practice Address - Fax:541-469-8015
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350054NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR298898Medicaid
P93797Medicare UPIN
ORR154700Medicare PIN