Provider Demographics
NPI:1316736986
Name:BOERNER, MARIN (RN)
Entity type:Individual
Prefix:
First Name:MARIN
Middle Name:
Last Name:BOERNER
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 MADRINA CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6335
Mailing Address - Country:US
Mailing Address - Phone:314-406-4939
Mailing Address - Fax:
Practice Address - Street 1:6709 ACADEMY RD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3363
Practice Address - Country:US
Practice Address - Phone:505-308-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016023225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse