Provider Demographics
NPI:1104197524
Name:BOEHLER, JANA R (C-PAC)
Entity Type:Individual
Prefix:MISS
First Name:JANA
Middle Name:R
Last Name:BOEHLER
Suffix:
Gender:F
Credentials:C-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2410
Mailing Address - Country:US
Mailing Address - Phone:801-504-6117
Mailing Address - Fax:801-504-6328
Practice Address - Street 1:468 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2410
Practice Address - Country:US
Practice Address - Phone:801-504-6117
Practice Address - Fax:801-504-6328
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT87997143-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS178545Medicare PIN