MEDICARE: MARLISSA BOYLES FNP

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	209.013074	IL

General Provider Information

NPI Number	:	1316314933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLISSA BOYLES FNP

Provider Business Mailing Address
First Line	:	405 S WHITTLE AVE
Second Line	:
City	:	OLNEY
State	:	IL
Zip	:	62450-2262
Country	:	US
Telephone Number	:	618-364-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 S WHITTLE AVE
Second Line	:
City	:	OLNEY
State	:	IL
Zip	:	62450-2262
Country	:	US
Telephone Number	:	618-364-1009
Fax Number	:

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

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	12/15/2025

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Directions to “ MARLISSA BOYLES FNP” Practice Location

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