Provider Demographics
NPI:1063474286
Name:BOEHMLER, KIMBERLY (CNM)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BOEHMLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 824804
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4804
Mailing Address - Country:US
Mailing Address - Phone:302-778-2229
Mailing Address - Fax:302-504-5010
Practice Address - Street 1:532 GREENHILL AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-1851
Practice Address - Country:US
Practice Address - Phone:302-778-2229
Practice Address - Fax:302-778-2250
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELK0000135367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1295738896OtherST FRANCIS HOSPITAL
S38367Medicare UPIN