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AGNES BOEHNING APN-FNP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1821134115

Individual Registrant:
 AGNES  BOEHNING APN-FNP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
819 E MCCORD ST  CENTRALIA, IL 62801-3044 US
Tel: 618-533-1313  Fax: 618-533-3711

Contact information for business:
4117 S WATER TOWER PL SUITE D MOUNT VERNON, IL 62864-6567 US
Tel: 618-242-4848  Fax: 618-242-4198

Registration Information:
NPI: 1821134115
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
IL209003194

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
LICENSE209003194IL01




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