Provider Demographics
NPI:1376130468
Name:BOEHM, MARY FRANCES
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:FRANCES
Last Name:BOEHM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 27TH ST SE LOT 94
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-5249
Mailing Address - Country:US
Mailing Address - Phone:701-441-1847
Mailing Address - Fax:
Practice Address - Street 1:1015 27TH ST SE LOT 94
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-5249
Practice Address - Country:US
Practice Address - Phone:701-441-1847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant