Provider Demographics
NPI:1891549440
Name:BOECKER, HEATHER MARIE (LPN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:BOECKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 W CANAL ST
Mailing Address - Street 2:
Mailing Address - City:OTTOVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45876-8752
Mailing Address - Country:US
Mailing Address - Phone:419-604-0374
Mailing Address - Fax:
Practice Address - Street 1:385 W CANAL ST
Practice Address - Street 2:
Practice Address - City:OTTOVILLE
Practice Address - State:OH
Practice Address - Zip Code:45876-8752
Practice Address - Country:US
Practice Address - Phone:419-604-0374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.157626.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty