Basic Information
Provider Information
NPI: 1790180826
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYER
FirstName: FELICITY
MiddleName: SHAWN
NamePrefix: MS.
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2164 WEXFORD RD
Address2:  
City: PALMYRA
State: PA
PostalCode: 170789256
CountryCode: US
TelephoneNumber: 7175332798
FaxNumber:  
Practice Location
Address1: 680 BLAIR MILL RD
Address2:  
City: HORSHAM
State: PA
PostalCode: 190442223
CountryCode: US
TelephoneNumber: 2159029014
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/31/2014
LastUpdateDate: 10/31/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XSP014419PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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