MEDICARE: LORENA ROSALES BOYLE FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F342831	NY
2	363LF0000X	Family Nurse Practitioner	NP95018333	CA

General Provider Information

NPI Number	:	1114466281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORENA ROSALES BOYLE FNP-BC

Provider Business Mailing Address
First Line	:	1515 SCOTT ST STE 1
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3511
Country	:	US
Telephone Number	:	415-502-8806
Fax Number	:	415-502-8811

Provider Business Practice Location Address
First Line	:	1515 SCOTT ST STE 1
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3511
Country	:	US
Telephone Number	:	415-502-8806
Fax Number	:	415-502-8811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	08/06/2023

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