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General NPI Number Information
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NPI Number | 1134840903
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Entity Type | Individual
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Provider Name | CHRISTINE SHANA BOEHMER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/08/2022
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 3569 RIDGE RD
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City | CLEVELAND
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State | OH
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Zip | 44102-5443
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Country | US
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Telephone | 216-281-0872
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Fax | 216-281-9721
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Provider Business Mailing Address
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Address Line | 2755 N LINCOLN AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60614-7438
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085010137
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License Number State | IL
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