Healthcare Provider Details

I. General information

NPI: 1467452383
Provider Name (Legal Business Name): KAREN BOHEEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 10/21/2024
Certification Date: 10/16/2024
Deactivation Date: 03/21/2006
Reactivation Date: 04/07/2006

III. Provider practice location address

1492 W ANTELOPE DR #205
LAYTON UT
84041-1139
US

IV. Provider business mailing address

1492 W ANTELOPE DR #205
LAYTON UT
84041-1139
US

V. Phone/Fax

Practice location:
  • Phone: 801-728-0600
  • Fax: 801-728-0606
Mailing address:
  • Phone: 801-728-0600
  • Fax: 801-728-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO01389
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number99-370139-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: