Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 443049 | CA |
NPI | 1003280934 |
---|---|
Provider Name | Brenda Boyle |
First Address | San Bernardino, CA 92408 |
Second Address | San Bernardino, CA 92410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2015 |
Last Update Date | 16/11/2015 |