Doctor Name: | MRS. MARY ANN BOERNER |
NPI Number: | 1437121043 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 493 |
Business Practice Address: | 1 Choctaw Way Talihina, OK - 745712022 |
Business Phone Number: | 9185677000 |
Business Fax Number: | 9185677044 |
Mailing Address: | 507 Roberts St, TALIHINA |
State: | OK |
Postal Code: | 745712000 |
Phone Number: | 9185673128 |
Fax Number: | |
NPI Enumeration Date: | 02/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 493 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |