Individual
AGNES BOEHNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN-FNP
Contact information
Practice address
819 E MCCORD ST, CENTRALIA, IL 62801-3044
(618) 533-1313
(618) 533-3711
Mailing address
4117 S WATER TOWER PL, SUITE D, MOUNT VERNON, IL 62864-6567
(618) 242-4848
(618) 242-4198
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209003194
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209003194
LICENSE
IL
Enumeration date
01/30/2007
Last updated
02/25/2011
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