Healthcare Provider Details

I. General information

NPI: 1346686102
Provider Name (Legal Business Name): AUDREY MARIA BOYLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY MARIA RUSKOWSKI APRN

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN00516
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00516
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: