Healthcare Provider Details

I. General information

NPI: 1528303005
Provider Name (Legal Business Name): BONNIE BOSWELL BOONE RN, IBCLC, RLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SKYLYN DR
SPARTANBURG SC
29307-1041
US

IV. Provider business mailing address

120 S LAKE EMORY DR
INMAN SC
29349-7257
US

V. Phone/Fax

Practice location:
  • Phone: 864-573-5000
  • Fax: 864-573-3399
Mailing address:
  • Phone: 864-472-4692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: