Healthcare Provider Details

I. General information

NPI: 1225141716
Provider Name (Legal Business Name): BRENDA K. BOYTIM APN-C, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5437 8TH STREET
FORT DIX NJ
08640-5006
US

IV. Provider business mailing address

2 HEWLINGS DR
MARLTON NJ
08053-5310
US

V. Phone/Fax

Practice location:
  • Phone: 609-562-2999
  • Fax: 609-562-5426
Mailing address:
  • Phone: 856-596-1966
  • Fax: 856-596-1966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: