Provider Demographics
NPI:1467673962
Name:BOECKMAN, JANET LOUISE (CPNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LOUISE
Last Name:BOECKMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 BALGREEN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906
Mailing Address - Country:US
Mailing Address - Phone:419-522-3341
Mailing Address - Fax:419-522-1110
Practice Address - Street 1:770 BALGREEN DR STE 101
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906
Practice Address - Country:US
Practice Address - Phone:419-522-3341
Practice Address - Fax:419-522-1110
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.01834-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics