Provider Demographics
NPI:1477862902
Name:BOERNER, KASEY ANN (APNP)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:ANN
Last Name:BOERNER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:ANN
Other - Last Name:COEY-BOERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:119 E BELL ST
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4993
Mailing Address - Country:US
Mailing Address - Phone:920-969-1768
Mailing Address - Fax:
Practice Address - Street 1:119 E BELL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4993
Practice Address - Country:US
Practice Address - Phone:920-969-1768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4205-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily