Provider Demographics
NPI:1043819014
Name:BOENSCH, ERIN (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOENSCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9577 W SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:REESE
Mailing Address - State:MI
Mailing Address - Zip Code:48757-9464
Mailing Address - Country:US
Mailing Address - Phone:989-798-5213
Mailing Address - Fax:
Practice Address - Street 1:4272 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9501
Practice Address - Country:US
Practice Address - Phone:810-919-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601012705363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant