Provider Demographics
NPI:1194801068
Name:BOEHME, DEBRA
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BOEHME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 TRAMWAY LANE NE
Mailing Address - Street 2:UNIT 5
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122
Mailing Address - Country:US
Mailing Address - Phone:505-856-7080
Mailing Address - Fax:
Practice Address - Street 1:785 TRAMWAY LANE NE
Practice Address - Street 2:UNIT 5
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122
Practice Address - Country:US
Practice Address - Phone:505-856-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM873171100000X
NM00014277146M00000X
NM0075171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health