Provider Demographics
NPI:1548580707
Name:BOEHRER, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOEHRER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1692 E REDBUD RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:OK
Mailing Address - Zip Code:73093-9285
Mailing Address - Country:US
Mailing Address - Phone:405-426-7070
Mailing Address - Fax:
Practice Address - Street 1:1620 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6653
Practice Address - Country:US
Practice Address - Phone:405-203-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator