MEDICARE: MRS. KATHERINE MARIE O'BOYLE CNP

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	363LP2300X	Primary Care Nurse Practitioner	APRN.CNP021241	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952824138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE MARIE O'BOYLE CNP

Provider Business Mailing Address
First Line	:	11395 SADDLEWOOD LN
Second Line	:
City	:	CONCORD TOWNSHIP
State	:	OH
Zip	:	44077-8965
Country	:	US
Telephone Number	:	855-247-1940
Fax Number	:

Provider Business Practice Location Address
First Line	:	8655 MARKET ST
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4406
Country	:	US
Telephone Number	:	440-701-7620
Fax Number	:	440-701-7621

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

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	03/07/2023

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