Provider Demographics
NPI:1235571217
Name:BOEGER, LISA RACHEL (NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RACHEL
Last Name:BOEGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:RACHEL
Other - Last Name:VADIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 809
Mailing Address - Street 2:BOX 2458
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09626-9997
Mailing Address - Country:US
Mailing Address - Phone:218-260-4700
Mailing Address - Fax:
Practice Address - Street 1:PSC 827
Practice Address - Street 2:BOX 1000
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09617-9998
Practice Address - Country:US
Practice Address - Phone:081-811-6317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60434868363LF0000X
MNR 160181 9363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily