Provider Demographics
NPI:1346366119
Name:BOERMAN, JANIS (ABC CERTIFIED)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:BOERMAN
Suffix:
Gender:F
Credentials:ABC CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 KINGERY HWY
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7561
Mailing Address - Country:US
Mailing Address - Phone:630-570-5004
Mailing Address - Fax:630-570-5059
Practice Address - Street 1:7219 KINGERY HWY
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7561
Practice Address - Country:US
Practice Address - Phone:630-570-5004
Practice Address - Fax:630-570-5059
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
0317320001Medicare NSC