Healthcare Provider Details

I. General information

NPI: 1033839758
Provider Name (Legal Business Name): COREY BOYTE RN, CCM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 SYLVAN RIDGE DR
TOLEDO OH
43623-1098
US

IV. Provider business mailing address

5837 SYLVAN RIDGE DR
TOLEDO OH
43623-1098
US

V. Phone/Fax

Practice location:
  • Phone: 419-490-6798
  • Fax: 888-838-0235
Mailing address:
  • Phone: 419-490-2698
  • Fax: 888-838-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN.402193
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: