Provider Demographics
NPI:1689700577
Name:BOEHRNS, RENEE A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:A
Last Name:BOEHRNS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29945 448TH AVE
Mailing Address - Street 2:
Mailing Address - City:VOLIN
Mailing Address - State:SD
Mailing Address - Zip Code:57072-5713
Mailing Address - Country:US
Mailing Address - Phone:605-263-2076
Mailing Address - Fax:
Practice Address - Street 1:3515 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4917
Practice Address - Country:US
Practice Address - Phone:605-668-3100
Practice Address - Fax:605-668-3460
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0440363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7662Medicare PIN
SDP23215Medicare UPIN