Provider Demographics
NPI:1093249450
Name:BOATMAN, CAROLYN M (DIPLAC, RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:BOATMAN
Suffix:
Gender:F
Credentials:DIPLAC, RN
Other - Prefix:
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Mailing Address - Street 1:9111 EDGE O WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-9372
Mailing Address - Country:US
Mailing Address - Phone:262-424-7451
Mailing Address - Fax:
Practice Address - Street 1:9111 EDGE O WOODS DR
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9372
Practice Address - Country:US
Practice Address - Phone:262-424-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI618-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist