MEDICARE: AUDREY PATRICIA BOE CRNP

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	363LF0000X	Family Nurse Practitioner	SP032513	PA

General Provider Information

NPI Number	:	1114712783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY PATRICIA BOE CRNP

Provider Business Mailing Address
First Line	:	500 W MONROE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-3671
Country	:	US
Telephone Number	:	877-751-5783
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W MONROE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60661-3671
Country	:	US
Telephone Number	:	877-751-5783
Fax Number	:

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

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/14/2025

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