Provider Demographics
NPI:1508899550
Name:BOAK, RENEE ERICA (QMHA)
Entity Type:Individual
Prefix:MISS
First Name:RENEE
Middle Name:ERICA
Last Name:BOAK
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 SE REEDWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5127
Mailing Address - Country:US
Mailing Address - Phone:518-225-2564
Mailing Address - Fax:503-287-7684
Practice Address - Street 1:2908 NE KILLINGSWORTH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6812
Practice Address - Country:US
Practice Address - Phone:503-287-8009
Practice Address - Fax:503-287-7684
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered372600000XNursing Service Related ProvidersAdult Companion