Healthcare Provider Details

I. General information

NPI: 1003846460
Provider Name (Legal Business Name): DENISE R BOYLE MSN-BCFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6231 CANTON CENTER ROAD STE 101
CANTON MI
48187-2694
US

IV. Provider business mailing address

6231 CANTON CENTER ROAD STE 101
CANTON MI
48187-2694
US

V. Phone/Fax

Practice location:
  • Phone: 734-459-7444
  • Fax: 734-459-7755
Mailing address:
  • Phone: 734-459-7444
  • Fax: 734-459-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704145525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: