Provider Demographics
NPI:1598863359
Name:BOYLE, DIANA LEE (RN CFNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LEE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:RN CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-1157
Mailing Address - Country:US
Mailing Address - Phone:304-265-1288
Mailing Address - Fax:304-265-6558
Practice Address - Street 1:718 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354
Practice Address - Country:US
Practice Address - Phone:304-265-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV016659000Medicaid
R35261Medicare UPIN