MEDICARE: CELESTE A BOECKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	5186	OK

General Provider Information

NPI Number	:	1083903728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTE A BOECKMAN

Provider Business Mailing Address
First Line	:	4300 W MEMORIAL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8304
Country	:	US
Telephone Number	:	405-752-3962
Fax Number	:	405-752-3963

Provider Business Practice Location Address
First Line	:	13901 MCAULEY BLVD STE 303
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-8704
Country	:	US
Telephone Number	:	405-748-5806
Fax Number	:	405-752-3963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	07/28/2022

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Directions to “ CELESTE A BOECKMAN ” Practice Location

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