Provider Demographics
NPI:1881738359
Name:BOEHMER, TARA NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:NICOLE
Last Name:BOEHMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:NICOLE
Other - Last Name:MCKNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:920 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3743
Mailing Address - Country:US
Mailing Address - Phone:937-286-4744
Mailing Address - Fax:
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.354009163WW0000X
OH400443531204376K00000X
OHCNP.022062363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No376K00000XNursing Service Related ProvidersNurse's Aide