Provider Demographics
NPI:1710985494
Name:BOYLE-GIANNINI, KATHLEEN MARY (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:BOYLE-GIANNINI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-0482
Mailing Address - Country:US
Mailing Address - Phone:610-287-3975
Mailing Address - Fax:215-283-7056
Practice Address - Street 1:1120 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19436-1000
Practice Address - Country:US
Practice Address - Phone:215-283-7077
Practice Address - Fax:215-283-7056
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP001558H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S11211Medicare UPIN