Provider Demographics
NPI:1215651187
Name:BOEKA, TAMARA JANE
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:JANE
Last Name:BOEKA
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 1:19854 HACKBERRY DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-4546
Mailing Address - Country:US
Mailing Address - Phone:402-213-9207
Mailing Address - Fax:
Practice Address - Street 1:19854 HACKBERRY DR
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-4546
Practice Address - Country:US
Practice Address - Phone:402-213-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider