MEDICARE: DEANNA BOOK BOESEN MD PC

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	2084P0804X	Child & Adolescent Psychiatry Physician	25601	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07281	OTHER	IA	WELLMARK BLUE CROSS BLUE

General Provider Information

NPI Number	:	1760694939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEANNA BOOK BOESEN MD PC

Provider Business Mailing Address
First Line	:	3408 WOODLAND AVE
Second Line	:	SUITE 502
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-225-6044
Fax Number	:	515-327-5995

Provider Business Practice Location Address
First Line	:	3408 WOODLAND AVE
Second Line	:	SUITE 502
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-225-6044
Fax Number	:	515-327-5995

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DEANNA BOOK BOESEN
Credential	:	MD
Telephone Number	:	515-225-6044

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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