Provider Demographics
NPI:1265697007
Name:BOESCHE, KATHERINE (RN)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:
Last Name:BOESCHE
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:PO BOX 636
Mailing Address - Street 2:197 MOHAWK RD
Mailing Address - City:OLD FORGE
Mailing Address - State:NY
Mailing Address - Zip Code:13420-0636
Mailing Address - Country:US
Mailing Address - Phone:315-369-3844
Mailing Address - Fax:
Practice Address - Street 1:197 MOHAWK RD
Practice Address - Street 2:
Practice Address - City:OLD FORGE
Practice Address - State:NY
Practice Address - Zip Code:13420
Practice Address - Country:US
Practice Address - Phone:315-369-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295283-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02898002OtherMEDICAID PROVIDER NUMBER