Provider Demographics
NPI:1972980274
Name:BOYNE, REBECCA LYNN (APRN-C)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:BOYNE
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MRS
Other - First Name:REBECCA
Other - Middle Name:LYNN
Other - Last Name:LICHWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-6200
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:3229 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3018
Practice Address - Country:US
Practice Address - Phone:513-584-4268
Practice Address - Fax:513-584-6452
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9308901363L00000X
OHAPRN.CNP.0036242363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015026500Medicaid