Provider Demographics
NPI:1932501574
Name:BOYLES, MARYJO (LPN)
Entity Type:Individual
Prefix:
First Name:MARYJO
Middle Name:
Last Name:BOYLES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 DUNCAN DR
Mailing Address - Street 2:BLDG 1440
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31409-5107
Mailing Address - Country:US
Mailing Address - Phone:912-315-5454
Mailing Address - Fax:
Practice Address - Street 1:230 DUNCAN DR
Practice Address - Street 2:BLDG 1440
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31409-5107
Practice Address - Country:US
Practice Address - Phone:912-315-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN074882164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse