Doctor Name: | LAURIE K BOEHM |
NPI Number: | 1013090018 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | PA9103644 |
Business Practice Address: | 7720 Us Highway 98 W Suite 110 Miramar Beach, FL - 325507230 |
Business Phone Number: | 8502671603 |
Business Fax Number: | 8506223342 |
Mailing Address: | 7720 Us Highway 98 W, Suite 110 MIRAMAR BEACH |
State: | FL |
Postal Code: | 325507230 |
Phone Number: | 8502671603 |
Fax Number: | 8506223342 |
NPI Enumeration Date: | 10/23/2006 |
NPI Last Update Date: | 09/17/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA9103644 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |