Provider Demographics
NPI:1154894210
Name:BOEHME, ELIZABETH ANN (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:BOEHME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6037
Mailing Address - Country:US
Mailing Address - Phone:314-210-2302
Mailing Address - Fax:
Practice Address - Street 1:DUBLIN FAMILY MEDICINE
Practice Address - Street 2:118 BROAD ST.
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3211
Practice Address - Country:US
Practice Address - Phone:540-674-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant