Provider Demographics
NPI:1982058251
Name:BOYLES, MARLO MCHUGH
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:MCHUGH
Last Name:BOYLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 MORNING RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2275
Mailing Address - Country:US
Mailing Address - Phone:336-575-3074
Mailing Address - Fax:336-293-6212
Practice Address - Street 1:4328 MORNING RIDGE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2275
Practice Address - Country:US
Practice Address - Phone:336-575-3074
Practice Address - Fax:336-293-6212
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education