Provider Demographics
NPI:1780718973
Name:BOITNOTT, EDYTHE A (NP)
Entity type:Individual
Prefix:
First Name:EDYTHE
Middle Name:A
Last Name:BOITNOTT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 BROAD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2301
Mailing Address - Country:US
Mailing Address - Phone:434-791-2600
Mailing Address - Fax:434-792-5347
Practice Address - Street 1:129 BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2301
Practice Address - Country:US
Practice Address - Phone:434-791-2600
Practice Address - Fax:434-792-5347
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024165823363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021503D97Medicare PIN