Provider Demographics
NPI:1487958005
Name:BOYER, JAN LIENKE (RN, CDE)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:LIENKE
Last Name:BOYER
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 FLORA DR
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815-5126
Mailing Address - Country:US
Mailing Address - Phone:775-397-5380
Mailing Address - Fax:775-738-7499
Practice Address - Street 1:239 FLORA DR
Practice Address - Street 2:
Practice Address - City:SPRING CREEK
Practice Address - State:NV
Practice Address - Zip Code:89815-5126
Practice Address - Country:US
Practice Address - Phone:775-397-5380
Practice Address - Fax:775-738-7499
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN52119163WD0400X
NVAPRN001631364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1487958005Medicaid