Healthcare Provider Details

I. General information

NPI: 1417300898
Provider Name (Legal Business Name): BRIDGITTE BOEHM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2016
Last Update Date: 07/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NAPOLEON AVE
NEW ORLEANS LA
70115-6914
US

IV. Provider business mailing address

5040 ITHACA ST
METAIRIE LA
70006-2540
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-3650
  • Fax:
Mailing address:
  • Phone: 504-914-9611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP08970
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: