Healthcare Provider Details

I. General information

NPI: 1417456757
Provider Name (Legal Business Name): MRS. GILLIAN JOHNNY-BOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5548 KAREN ELAINE DR APT 1422
NEW CARROLLTON MD
20784-4161
US

IV. Provider business mailing address

4030 HANSON OAKS DR
HYATTSVILLE MD
20784-2315
US

V. Phone/Fax

Practice location:
  • Phone: 124-043-5872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: