Boley, Theresa M

Boley, Theresa M is an individual health care provider with primary practice located at 315 W Carpenter St 2Nd Floor, Springfield IL 62702-4901. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Boley, Theresa M can be contacted via phone (217) 545-7422.

Contact Information

Primary practice address
315 W Carpenter St 2Nd Floor Springfield IL 62702-4901
Phone: (217) 545-7422
Fax: (217) 545-7053
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209000839 Illinois

Profile Details

NPI number 1184605743
LBN Legal business name Boley, Theresa M
Credentials Certified Family Nurse Practitioner (CFNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 10th, 2005
Last updated Oct 24th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184605743 NPPES
Illinois MEDICAID 449580260001

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