MEDICARE: CHARLENE BOATRIGHT FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95017099	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95017099	OTHER	CA	NURSE PRACTITIONER LICENSE

General Provider Information

NPI Number	:	1477133130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLENE BOATRIGHT FNP

Provider Business Mailing Address
First Line	:	3813 VILLAGE RD
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-1112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SAN RAMON VALLEY BLVD STE 102
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4021
Country	:	US
Telephone Number	:	925-838-4900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	04/08/2021

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Directions to “ CHARLENE BOATRIGHT FNP” Practice Location

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