Provider Demographics
NPI:1154416451
Name:BOERNER, NANCY SUMIRE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:SUMIRE
Last Name:BOERNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:SUMIRE
Other - Last Name:SHIGAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:28821 VIA BUENA VISTA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5556
Mailing Address - Country:US
Mailing Address - Phone:949-499-7645
Mailing Address - Fax:949-489-9981
Practice Address - Street 1:31872 COAST HWY
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6773
Practice Address - Country:US
Practice Address - Phone:949-499-7645
Practice Address - Fax:949-499-7532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE83306Medicare UPIN
CAWA44509CMedicare PIN