Provider Demographics
NPI:1992511331
Name:BOYSEN, EMMA MICHILLE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:MICHILLE
Last Name:BOYSEN
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 1:2469 BUCKINGHAM RD APT 3H
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2487
Mailing Address - Country:US
Mailing Address - Phone:402-720-7901
Mailing Address - Fax:
Practice Address - Street 1:1535 N GARFIELD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-3633
Practice Address - Country:US
Practice Address - Phone:402-720-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care