Individual
KELLY M BOESCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
618 CORNWALL RD, BUILDING 2, LEBANON, PA 17042-7089
(717) 279-6700
(717) 279-6759
Mailing address
PO BOX 300, 4TH & WILLOW STREETS, LEBANON, PA 17042-0300
(717) 270-7780
(717) 274-9746
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
SP013294
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102888103 0001
—
PA
01
—
SP013294
LICENSE
PA
Enumeration date
08/27/2013
Last updated
11/06/2014
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