Provider Demographics
NPI:1437982725
Name:BOYLE, DEIDRE LOUISE (RN)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:LOUISE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:LOUISE
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18 SURREY HILL LN
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-9726
Mailing Address - Country:US
Mailing Address - Phone:203-536-1138
Mailing Address - Fax:
Practice Address - Street 1:1000 ELMWOOD AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3093
Practice Address - Country:US
Practice Address - Phone:585-271-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY535677163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice