Healthcare Provider Details

I. General information

NPI: 1033622741
Provider Name (Legal Business Name): NICOLE BOONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 N MAIN ST
FINDLAY OH
45840-3972
US

IV. Provider business mailing address

1918 N MAIN ST
FINDLAY OH
45840-3818
US

V. Phone/Fax

Practice location:
  • Phone: 419-422-3711
  • Fax:
Mailing address:
  • Phone: 419-425-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1502610
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: