Provider Demographics
NPI:1194327981
Name:BOAN, EVELYN BEATRIX RATTU (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:BEATRIX RATTU
Last Name:BOAN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15031 OAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2627
Mailing Address - Country:US
Mailing Address - Phone:626-244-4351
Mailing Address - Fax:
Practice Address - Street 1:15031 OAKWOOD LN
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-2627
Practice Address - Country:US
Practice Address - Phone:626-244-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95014057363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care