MEDICARE: LEAH BOEVE FNP

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	4704314023	MI

General Provider Information

NPI Number	:	1750101895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH BOEVE FNP

Provider Business Mailing Address
First Line	:	12151 LINDEN DR
Second Line	:
City	:	MARNE
State	:	MI
Zip	:	49435-9684
Country	:	US
Telephone Number	:	616-889-6011
Fax Number	:

Provider Business Practice Location Address
First Line	:	675 W RANDALL ST
Second Line	:
City	:	COOPERSVILLE
State	:	MI
Zip	:	49404-1305
Country	:	US
Telephone Number	:	616-889-6011
Fax Number	:

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

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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