Provider Demographics
NPI:1659966042
Name:BOEDEKER (EBERHARD), ANGELA (CNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:BOEDEKER (EBERHARD)
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12175 HEFFNER RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45644-9661
Mailing Address - Country:US
Mailing Address - Phone:740-572-3088
Mailing Address - Fax:
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1654
Practice Address - Country:US
Practice Address - Phone:740-572-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028441363LA2200X
OH0028441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner