Individual
KELLY ANN BOIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PPCNP-BC
Contact information
Practice address
14001 RIDGEDALE DR, STE 100, MINNETONKA, MN 55305-1781
(952) 473-0211
(952) 473-7908
Mailing address
14001 RIDGEDALE DR, STE 100, MINNETONKA, MN 55305-1781
(952) 473-0211
(952) 473-7908
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
R1121373
MN
363LP0200X
Pediatric Nurse Practitioner
Primary
CNP0812
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
731306300
—
MN
Enumeration date
02/07/2006
Last updated
05/03/2016
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