Provider Demographics
NPI:1285103366
Name:BOARDMAN, SENA (APN -BC)
Entity type:Individual
Prefix:
First Name:SENA
Middle Name:
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:APN -BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8747 W BRYN MAWR AVE APT 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3684
Mailing Address - Country:US
Mailing Address - Phone:312-659-3821
Mailing Address - Fax:
Practice Address - Street 1:290 W LOOP RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2034
Practice Address - Country:US
Practice Address - Phone:630-868-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-18
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily