Provider Demographics
NPI:1457605214
Name:BOYLE, MADELYN WILEY (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:WILEY
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N ORANGE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2998
Mailing Address - Country:US
Mailing Address - Phone:406-327-3350
Mailing Address - Fax:406-327-3355
Practice Address - Street 1:900 N ORANGE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2998
Practice Address - Country:US
Practice Address - Phone:406-327-3350
Practice Address - Fax:406-327-3355
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20470363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant