MEDICARE: CHANELL BOONE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider		NE
2	376J00000X	Homemaker		NE

General Provider Information

NPI Number	:	1609689710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANELL BOONE

Provider Business Mailing Address
First Line	:	3160 AMES AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-2759
Country	:	US
Telephone Number	:	303-520-3042
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 AMES AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-2759
Country	:	US
Telephone Number	:	303-520-3042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	03/28/2025

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Directions to “ CHANELL BOONE ” Practice Location

Language	Start Address	Practice Location

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