Provider Demographics
NPI:1700635661
Name:BOEHLKE, ERICA NICOLE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:NICOLE
Last Name:BOEHLKE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:NICOLE
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 E CORPORATE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-2953
Mailing Address - Country:US
Mailing Address - Phone:208-283-7314
Mailing Address - Fax:
Practice Address - Street 1:280 E CORPORATE DR STE 200
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2953
Practice Address - Country:US
Practice Address - Phone:208-283-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID79045363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health