Provider Demographics
NPI:1215273735
Name:BOERSEN, NANCY (RN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BOERSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7354 GREENTREE DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8747
Mailing Address - Country:US
Mailing Address - Phone:616-662-0942
Mailing Address - Fax:
Practice Address - Street 1:919 44TH AVE
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-9193
Practice Address - Country:US
Practice Address - Phone:616-797-9920
Practice Address - Fax:616-797-9921
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704144074163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse