Provider Demographics
NPI:1649650953
Name:BOYLE, AMY (RDN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3723
Mailing Address - Country:US
Mailing Address - Phone:612-863-4802
Mailing Address - Fax:
Practice Address - Street 1:7373 FRANCE AVE S STE 202
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4551
Practice Address - Country:US
Practice Address - Phone:952-835-1311
Practice Address - Fax:952-428-0099
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3133133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered