MEDICARE: CELINE BOERS NP

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	363L00000X	Nurse Practitioner	041183241	IL

General Provider Information

NPI Number	:	1750382032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELINE BOERS NP

Provider Business Mailing Address
First Line	:	1427 FOREST AVE
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-6049
Country	:	US
Telephone Number	:	773-891-2507
Fax Number	:

Provider Business Practice Location Address
First Line	:	4235 W NORTH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4852
Country	:	US
Telephone Number	:	773-278-6868
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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