Provider Demographics
NPI:1033692843
Name:BOEHNKE, SUSAN (NP-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOEHNKE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 BELLAIRE BLVD
Mailing Address - Street 2:STE 575
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4535
Mailing Address - Country:US
Mailing Address - Phone:713-575-3686
Mailing Address - Fax:713-575-3688
Practice Address - Street 1:911 WALLING ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77009-3648
Practice Address - Country:US
Practice Address - Phone:281-206-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX711236OtherTEXAS BOARD OF NURSING