Provider Demographics
NPI:1467241729
Name:BOEHM, ELIZABETH (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BOEHM
Suffix:
Gender:
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5574 SOMERSET BLVD
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-8352
Mailing Address - Country:US
Mailing Address - Phone:812-302-2657
Mailing Address - Fax:
Practice Address - Street 1:5574 SOMERSET BLVD
Practice Address - Street 2:
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-8352
Practice Address - Country:US
Practice Address - Phone:812-302-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28275214A163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty