Healthcare Provider Details

I. General information

NPI: 1881738359
Provider Name (Legal Business Name): TARA NICOLE BOEHMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA NICOLE MCKNIGHT STNA

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

920 BUCKINGHAM RD
DAYTON OH
45419-3743
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2126
  • Fax:
Mailing address:
  • Phone: 937-286-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN.354009
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400443531204
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP.022062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: