Provider Demographics
NPI:1649871708
Name:BOYLE, RACHEL SUZANN (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:SUZANN
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 1:509 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9674
Mailing Address - Country:US
Mailing Address - Phone:541-582-0505
Mailing Address - Fax:541-582-0778
Practice Address - Street 1:509 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9674
Practice Address - Country:US
Practice Address - Phone:541-582-0505
Practice Address - Fax:541-582-0778
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061811363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA061811OtherBPOA