Basic Information
| Provider Information | |||||||||
| NPI: | 1861031825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOETGER | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | JOANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1910 SASSAFRAS ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165022716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144527879 | ||||||||
| FaxNumber: | 8144552628 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 SASSAFRAS ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | ERIE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 165022716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144527879 | ||||||||
| FaxNumber: | 8144552628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2019 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0106X | SP021155 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Occupational Health | 363L00000X | SP021155 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.