Healthcare Provider Details

I. General information

NPI: 1043819014
Provider Name (Legal Business Name): ERIN BOENSCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4272 W VIENNA RD
CLIO MI
48420-9501
US

IV. Provider business mailing address

9577 W SAGINAW RD
REESE MI
48757-9464
US

V. Phone/Fax

Practice location:
  • Phone: 810-919-9415
  • Fax:
Mailing address:
  • Phone: 989-798-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601012705
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: