Provider Demographics
NPI:1487351003
Name:BOARDLEY, AMBERLY (RN)
Entity type:Individual
Prefix:
First Name:AMBERLY
Middle Name:
Last Name:BOARDLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-3634
Mailing Address - Country:US
Mailing Address - Phone:443-786-8673
Mailing Address - Fax:
Practice Address - Street 1:144 PENNY LN
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-3634
Practice Address - Country:US
Practice Address - Phone:443-786-8673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR217924163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health