Provider Demographics
NPI:1821766163
Name:BOELENS, KRISTEN SUZANNE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SUZANNE
Last Name:BOELENS
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 1:67 WOODLAND PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GILBERTS
Mailing Address - State:IL
Mailing Address - Zip Code:60136-4002
Mailing Address - Country:US
Mailing Address - Phone:309-339-9566
Mailing Address - Fax:
Practice Address - Street 1:67 WOODLAND PARK CIR
Practice Address - Street 2:
Practice Address - City:GILBERTS
Practice Address - State:IL
Practice Address - Zip Code:60136-4002
Practice Address - Country:US
Practice Address - Phone:309-339-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily