Provider Demographics
NPI:1609174960
Name:BOYLL, JENNIFER FREW
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FREW
Last Name:BOYLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 E ROCKY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAROY
Mailing Address - State:WA
Mailing Address - Zip Code:99003-9649
Mailing Address - Country:US
Mailing Address - Phone:812-508-6909
Mailing Address - Fax:
Practice Address - Street 1:101 W CASCADE WAY STE 103
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6000
Practice Address - Country:US
Practice Address - Phone:509-413-2242
Practice Address - Fax:509-922-7947
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program