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General NPI Number Information
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NPI Number | 1013943158
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Entity Type | Individual
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Provider Name | IOLIENE BOENAU MD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 3914 W STRATFORD RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-1664
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Country | US
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Telephone | 757-460-5924
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Fax |
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Provider Business Mailing Address
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Address Line | 211 CHURCH ST
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-1003
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Country | US
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Telephone | 757-460-5924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0101223310
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License Number State | VA
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