Provider Demographics
NPI:1639173586
Name:BOYER, VIVIAN (CNM)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:BOYER
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S CHURCH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-1702
Mailing Address - Country:US
Mailing Address - Phone:724-887-6960
Mailing Address - Fax:724-887-6962
Practice Address - Street 1:508 S CHURCH ST STE 102
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-1702
Practice Address - Country:US
Practice Address - Phone:724-887-6960
Practice Address - Fax:724-887-6962
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008365L367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01500165Medicaid
S64296Medicare UPIN
PA01500165Medicaid