Mandy Marie Boehnert, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

035656 Issued in CT

Practice address

200 Seabury Dr
Bloomfield, CT 06002-5618

Phone

(860) 243-4022

NPI assigned

Oct 7, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1992467955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SEABURY DR",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060025618",
            "telephone_number": "860-243-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SEABURY DR",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060025618",
            "telephone_number": "860-243-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEHNERT",
        "first_name": "MANDY",
        "middle_name": "MARIE",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-07",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CT",
            "license": "035656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN",
            "identifier": "075383",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "mandyboehnert@seaburylife.org",
            "affiliation": "N",
            "address_1": "200 Seabury Dr",
            "city": "Bloomfield",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060025618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bloomfield Pediatric Dentistry PLLC
• Bloomfield Urgent Care, LLC
• Blooming Wellness & Therapeutic Services LLC
• Rita Bobb-Rollins, DDS
• Body in Motion LLC
• Eric Bolella
• Melissa R Bombara
• Bonnie K. Scranton MSW LLC
• Lynn Borowiec
• Pamela Bouchard, PT

• Licensed Practical Nurse in Bloomfield, CT
• Providers in Bloomfield, CT by specialty
• Licensed Practical Nurse in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.