Provider Demographics
NPI:1699045765
Name:BOYLAN, MARIE THERESE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:THERESE
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 OXHEAD RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2357
Mailing Address - Country:US
Mailing Address - Phone:631-730-4810
Mailing Address - Fax:631-730-4854
Practice Address - Street 1:391 OXHEAD RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-730-4810
Practice Address - Fax:631-730-4854
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330611-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool