Individual
KELLY L BOEGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
812 N LOGAN AVE, PROVENA UNITED SAMARITANS MEDICAL CENT, DANVILLE, IL 61832
(217) 443-5000
Mailing address
2203 COUNTRY SQUIRE DR, URBANA, IL 61802-5603
(217) 443-5000
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
968445
IL
Other
Enumeration date
07/21/2008
Last updated
07/21/2008
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