Provider Demographics
NPI:1144202649
Name:BOYER, MARILYNDA S (APN)
Entity type:Individual
Prefix:MRS
First Name:MARILYNDA
Middle Name:S
Last Name:BOYER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1945
Mailing Address - Country:US
Mailing Address - Phone:609-230-9623
Mailing Address - Fax:
Practice Address - Street 1:2510 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3037
Practice Address - Country:US
Practice Address - Phone:843-626-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00041000363LF0000X
PASP007821363LF0000X
CO0991002363LF0000X
SC24558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO026061OtherKAISER COMMERCIAL NUMBER
NJ0026671Medicaid
CO02080541Medicaid
CO396926YK5YMedicare PIN
CO026061OtherKAISER COMMERCIAL NUMBER
NJ0026671Medicaid
NJ085117DR7Medicare PIN