| Doctor Name: | MARLISSA BOYLES |
| NPI Number: | 1316314933 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 209.013074 |
| Business Practice Address: | 201 E North Ave Flora, IL - 628392030 |
| Business Phone Number: | 6186628386 |
| Business Fax Number: | 6186624338 |
| Mailing Address: | Po Box 155, CHRISTOPHER |
| State: | IL |
| Postal Code: | 628220155 |
| Phone Number: | 6187242401 |
| Fax Number: | 6187244628 |
| NPI Enumeration Date: | 08/31/2015 |
| NPI Last Update Date: | 11/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209.013074 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |