Provider Demographics
NPI:1407839764
Name:BOE, NINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:M
Last Name:BOE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:OB/GYN, SUITE 2500
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-6219
Mailing Address - Fax:916-734-6047
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:OB/GYN, SUITE 2500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-6219
Practice Address - Fax:916-734-6047
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2011-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG77583207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G775830Medicaid
CA00G775830Medicaid
CAE99811Medicare UPIN