Provider Demographics
NPI:1821020884
Name:BOEHM, CAROL (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:BOEHM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4526
Mailing Address - Country:US
Mailing Address - Phone:207-861-3200
Mailing Address - Fax:207-861-3210
Practice Address - Street 1:200 KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4526
Practice Address - Country:US
Practice Address - Phone:207-861-3200
Practice Address - Fax:207-861-3210
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR087379363LF0000X
MECNP171125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216302100Medicaid
MD068NL630Medicare PIN
MD216302100Medicaid