Individual
MS. MARIA THERESE BOEDIGHEIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
3120 CLEARWATER DR, PRESCOTT, AZ 86305-7131
(928) 771-3704
(928) 771-0434
Mailing address
PO BOX 10880, PRESCOTT, AZ 86304-0880
(928) 759-5987
(928) 458-2039
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4435
AZ
363A00000X
Physician Assistant
85000971
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4435
AZ LICENSE
AZ
05
—
927112
—
AZ
Enumeration date
09/20/2005
Last updated
02/10/2017
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