Provider Demographics
NPI:1104087212
Name:BOYNE, SARAH TYLER (NP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:TYLER
Last Name:BOYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:BOYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:25 LONG CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2440
Mailing Address - Country:US
Mailing Address - Phone:207-535-1100
Mailing Address - Fax:
Practice Address - Street 1:155 FORE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2795
Practice Address - Country:US
Practice Address - Phone:207-893-0290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433881099Medicaid
MEP00694062OtherRAILROAD MEDICARE
MEP00694062OtherRAILROAD MEDICARE