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General NPI Number Information
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NPI Number | 1467259853
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Entity Type | Individual
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Provider Name | CHARLES RUSSELL BOEHM RN
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Gender | Male
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Dates
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Enumeration Date | 02/25/2025
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 84 MARGINAL WAY STE 700
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City | PORTLAND
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State | ME
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Zip | 04101-2481
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Country | US
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Telephone | 207-774-5816
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Fax | 207-987-5245
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Provider Business Mailing Address
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Address Line | 84 MARGINAL WAY STE 700
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City | PORTLAND
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State | ME
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Zip | 04101-2481
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Country | US
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Telephone | 207-774-5816
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Fax | 207-987-5245
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN30687
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License Number State | ME
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