Provider Demographics
NPI:1710082318
Name:BOYER, JEANETTE RAE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:RAE
Last Name:BOYER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1643
Mailing Address - Country:US
Mailing Address - Phone:301-606-2906
Mailing Address - Fax:
Practice Address - Street 1:1302 SAVANNAH RD
Practice Address - Street 2:LOURDES APONTE MD AND KEVEN WALLACE MD
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-645-6644
Practice Address - Fax:302-645-6790
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
S46231Medicare UPIN