Individual
MANDY MARIE BOEHNERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
200 SEABURY DR, BLOOMFIELD, CT 06002-5618
(860) 243-4022
Mailing address
200 SEABURY DR, BLOOMFIELD, CT 06002-5618
(860) 243-4022
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
035656
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
075383
CCN
CT
Enumeration date
10/07/2021
Last updated
10/07/2021
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