Provider Demographics
NPI:1639598675
Name:BOESGAARD, ALICIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:BOESGAARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2939 STILLCREST LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-7047
Mailing Address - Country:US
Mailing Address - Phone:317-414-2542
Mailing Address - Fax:
Practice Address - Street 1:2939 STILLCREST LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-7047
Practice Address - Country:US
Practice Address - Phone:317-414-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28158689A163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency