Provider Demographics
NPI:1396386611
Name:BOEHMER, AMIE (RN)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:
Last Name:BOEHMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22500 METRO PKWY STE 403
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-1943
Mailing Address - Country:US
Mailing Address - Phone:586-741-4142
Mailing Address - Fax:
Practice Address - Street 1:22500 METRO PKWY STE 403
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-1943
Practice Address - Country:US
Practice Address - Phone:586-741-4142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704306869163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse