MEDICARE: MISS SHAUNA MARIE BOOMS

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1619392081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHAUNA MARIE BOOMS

Provider Business Mailing Address
First Line	:	1875 S RUTH RD
Second Line	:
City	:	HARBOR BEACH
State	:	MI
Zip	:	48441-8135
Country	:	US
Telephone Number	:	989-315-1750
Fax Number	:

Provider Business Practice Location Address
First Line	:	1263 SAND BEACH RD
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-8817
Country	:	US
Telephone Number	:	989-269-9229
Fax Number	:	989-269-2587

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

Provider Enumeration Date	:	02/21/2014
Last Update Date	:	06/24/2024

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Directions to “ MISS SHAUNA MARIE BOOMS ” Practice Location

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