Provider Demographics
NPI:1538053939
Name:BOEHME, ELIZABETH BLANDI
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BLANDI
Last Name:BOEHME
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:BLANDI
Other - Last Name:GATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1512 CUB RUN RD
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40387-8481
Mailing Address - Country:US
Mailing Address - Phone:606-548-1070
Mailing Address - Fax:
Practice Address - Street 1:1512 CUB RUN RD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KY
Practice Address - Zip Code:40387-8481
Practice Address - Country:US
Practice Address - Phone:606-548-1070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator