Provider Demographics
NPI:1659583763
Name:RENWANZ BOYLE, ANDREA GRACE (DNSC, RN, BC)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:GRACE
Last Name:RENWANZ BOYLE
Suffix:
Gender:F
Credentials:DNSC, RN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 SPRING DR
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3924
Mailing Address - Country:US
Mailing Address - Phone:415-389-8413
Mailing Address - Fax:
Practice Address - Street 1:1600 HOLLOWAY AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1722
Practice Address - Country:US
Practice Address - Phone:415-338-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA825852363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health