Healthcare Provider Details

I. General information

NPI: 1396409611
Provider Name (Legal Business Name): ANNA BOEKE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 6TH AVE N
SAINT CLOUD MN
56303-2736
US

IV. Provider business mailing address

8691 116TH ST SE
CLEAR LAKE MN
55319-9493
US

V. Phone/Fax

Practice location:
  • Phone: 320-240-2829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8493
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: