MEDICARE: MRS. TRINA BOYLES NP-C

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	4704195097	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4704195097	OTHER	MI	RN
2	4704195097	OTHER	MI	NURSE PRACTITIONER
3	F0710369	OTHER		AMERICAN ACADEMY OF NURSE PRACTITIONERS

General Provider Information

NPI Number	:	1558677120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRINA BOYLES NP-C

Provider Business Mailing Address
First Line	:	916 MYRTLE ST
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-2326
Country	:	US
Telephone Number	:	269-659-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 E CHICAGO RD
Second Line	:
City	:	STURGIS
State	:	MI
Zip	:	49091-1993
Country	:	US
Telephone Number	:	269-651-7114
Fax Number	:

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

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	01/25/2017

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