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NPI Code Detail

MEDICARE: MISS MARY ELIZABETH BOONE PA-C

MEDICARE: MISS MARY ELIZABETH BOONE PA-C
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
1363A00000XPhysician Assistant0110003099VA

General Provider Information

NPI Number : 1619109766
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MARY ELIZABETH BOONE PA-C
Provider Business Mailing Address
First Line : 12006 KILARNEY DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22407-7207
Country : US
Telephone Number : 540-786-9771
Fax Number : 540-548-8803
Provider Business Practice Location Address
First Line : 12006 KILARNEY DR
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22407-7207
Country : US
Telephone Number : 540-786-9771
Fax Number : 540-548-8803
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2009
Last Update Date : 01/05/2012

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Directions to “ MISS MARY ELIZABETH BOONE PA-C” Practice Location

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