Healthcare Provider Details

I. General information

NPI: 1063412690
Provider Name (Legal Business Name): REBECCA ALYCE BOENSCH MSN, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BIRCH RUN RD
BIRCH RUN MI
48415-9609
US

IV. Provider business mailing address

9900 BIRCH RUN RD
BIRCH RUN MI
48415-9609
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-1501
  • Fax:
Mailing address:
  • Phone: 989-624-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704194205
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: