Provider Demographics
NPI:1447360334
Name:BOELENS, DENISE DIANE (ACNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:DIANE
Last Name:BOELENS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:DIANE
Other - Last Name:HEFLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 CENTER CT
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-9580
Mailing Address - Country:US
Mailing Address - Phone:309-737-7396
Mailing Address - Fax:
Practice Address - Street 1:1100 36TH AVENUE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265
Practice Address - Country:US
Practice Address - Phone:309-743-6700
Practice Address - Fax:309-764-2042
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAL113147363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04620OtherWELLMARK BCBS OF IA
P00284214OtherMEDICARE RAILROAD
IAQ58650Medicare UPIN
IAI16640Medicare PIN