Provider Demographics
NPI:1043615966
Name:BOER, LIANA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LIANA
Middle Name:ELIZABETH
Last Name:BOER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20311 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1784
Mailing Address - Country:US
Mailing Address - Phone:586-604-1537
Mailing Address - Fax:
Practice Address - Street 1:20311 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1784
Practice Address - Country:US
Practice Address - Phone:586-604-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005210363A00000X
MI5601007811363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant