Agnes Boehning, APN-FNP
Individual provider Active NPI Family Nurse Practitioner · Centralia, IL
NPI 1821134115 · NPPES record last updated Feb 25, 2011
Key facts
- NPI
- 1821134115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 209003194 (IL)
- Practice address
- 819 E McCord St
Centralia, IL 62801-3044 - Phone
- (618) 533-1313
- Fax
- (618) 533-3711
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209003194 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heartland Occupational Medicine Physicians of Illinois S C | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209003194 | IL | Yes |
Addresses
Primary practice location
819 E McCord St
Centralia, IL 62801-3044
Mailing address
4117 S Water Tower PL
Suite D
Mount Vernon, IL 62864-6567
Phone (618) 242-4848
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209003194 | Other | IL | LICENSE |
Other providers in Centralia, IL
- Joshua J Berger
- Bernard Rerri
- Elizabeth Ann Biagi III
- Michael Bird
- Blue Angels EMS Inc
- Bonan Brothers Properties Project #2, LLC
- Bonan Brothers Properties Project #3 LLC
- Katherine A Bookhout
- Adam Borges
- Megan Borland
All providers in Centralia, IL · Family Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.