Healthcare Provider Details

I. General information

NPI: 1184596249
Provider Name (Legal Business Name): SIERRA H BOETTCHER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81709 DR CARREON BLVD STE C3
INDIO CA
92201-5577
US

IV. Provider business mailing address

79855 DEREK ALAN DR
LA QUINTA CA
92253-8136
US

V. Phone/Fax

Practice location:
  • Phone: 760-541-5888
  • Fax: 760-391-5159
Mailing address:
  • Phone: 760-485-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95037060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: