Provider Demographics
NPI:1558520767
Name:BOYER, TERRI VON (RCNA)
Entity Type:Individual
Prefix:MRS
First Name:TERRI VON
Middle Name:
Last Name:BOYER
Suffix:
Gender:F
Credentials:RCNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42874 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-4980
Mailing Address - Country:US
Mailing Address - Phone:218-927-4123
Mailing Address - Fax:
Practice Address - Street 1:42874 EAGLE ST
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-4980
Practice Address - Country:US
Practice Address - Phone:218-927-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1033549-1-AFC163WH0200X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No163WH0200XNursing Service ProvidersRegistered NurseHome Health