Provider Information for 1316677354
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KRISTINE BOEHNKE
Sex: Female
NPI: 1316677354
Last Updated: 2022-06-13
Certification Date: 2022-06-13
Certification Date: 2022-06-13
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316677354 | ||||||||
| Enumeration Date | 2022-06-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6905 LILAC DR VENUS, TX 76084-3656 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 6905 LILAC DR VENUS, TX 76084-3656 United States Phone: 817-372-6700 | Fax: | ||||||||
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