Provider Demographics
NPI:1194426957
Name:BOYLES, TRACEE L (RN)
Entity type:Individual
Prefix:
First Name:TRACEE
Middle Name:L
Last Name:BOYLES
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 1:1520 ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-1472
Mailing Address - Country:US
Mailing Address - Phone:765-894-1187
Mailing Address - Fax:
Practice Address - Street 1:1520 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1472
Practice Address - Country:US
Practice Address - Phone:765-894-1187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28123445A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse