Individual
CHRISTINE ELIZABETH BOUMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6320 WEDGWOOD RD N, MAPLE GROVE, MN 55311-3647
(763) 268-0400
(763) 268-0405
Mailing address
6320 WEDGWOOD RD N, MAPLE GROVE, MN 55311-3647
(763) 268-0400
(763) 268-0405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1318
WI
363A00000X
Physician Assistant
Primary
9172
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1318
PA LICENSE
WI
05
—
41921500
—
WI
Enumeration date
08/30/2006
Last updated
03/19/2009
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