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General NPI Number Information
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NPI Number | 1700328523
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Entity Type | Individual
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Provider Name | EMILY MAIRE BOYLE AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/10/2016
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 4122 KEATON CROSSING BLVD
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City | O FALLON
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State | MO
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Zip | 63368-8218
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Country | US
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Telephone | 636-329-9077
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Fax | 636-329-9076
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Provider Business Mailing Address
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Address Line | 10 LOCHHAVEN LN
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City | BALLWIN
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State | MO
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Zip | 63021-8020
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Country | US
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Telephone | 314-578-5400
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2016039315
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License Number State | MO
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