Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | MD448722 | PA |
N | 207RP1001X | Pulmonary Disease | MD448722 | PA |
NPI | 1003013483 |
---|---|
Provider Name | Jessica Mary Boehmler |
First Address | Philadelphia, PA 19178-3311 |
Second Address | Allentown, PA 18103-6224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 03/02/2016 |