Provider Demographics
NPI:1215977459
Name:BOYDA, ELLEN K (CRNP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:K
Last Name:BOYDA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 E RIDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:RIDLEY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19078-3024
Mailing Address - Country:US
Mailing Address - Phone:610-532-8777
Mailing Address - Fax:610-532-1129
Practice Address - Street 1:3 E RIDLEY AVE
Practice Address - Street 2:
Practice Address - City:RIDLEY PARK
Practice Address - State:PA
Practice Address - Zip Code:19078-3024
Practice Address - Country:US
Practice Address - Phone:610-532-8777
Practice Address - Fax:610-532-1129
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004637B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS60800Medicare UPIN
PA013761XRUMedicare PIN