Provider Demographics
NPI:1356897664
Name:BOESCHENSTEIN, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BOESCHENSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-1386
Mailing Address - Country:US
Mailing Address - Phone:303-330-4864
Mailing Address - Fax:
Practice Address - Street 1:750 GUSDORF RD APT 507
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6292
Practice Address - Country:US
Practice Address - Phone:303-330-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist