Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP3239 | AZ |
NPI | 1003052804 |
---|---|
Provider Name | Jena Patrice Boynton |
First Address | Queen Creek, AZ 85242-5996 |
Second Address | Queen Creek, AZ 85242-5996 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2008 |
Last Update Date | 29/12/2008 |