Healthcare Provider Details

I. General information

NPI: 1477529485
Provider Name (Legal Business Name): CHARLES RICHARD BOYLE C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 STATE AVE
FARIBAULT MN
55021-6339
US

IV. Provider business mailing address

1311 GREENLEAF RD
FARIBAULT MN
55021-2223
US

V. Phone/Fax

Practice location:
  • Phone: 507-332-4864
  • Fax:
Mailing address:
  • Phone: 507-334-9485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 139390-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: