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General NPI Number Information
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NPI Number | 1174095269
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Entity Type | Individual
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Provider Name | JOMESA DE'LICE BOONE
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Gender | Female
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Dates
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Enumeration Date | 12/30/2018
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Last Update Date | 07/25/2024
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Provider Practice Location Address
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Address Line | 10411 HICKORY RIDGE RD APT B
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City | COLUMBIA
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State | MD
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Zip | 21044-4631
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Country | US
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Telephone | 443-518-0096
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Fax |
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Provider Business Mailing Address
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Address Line | 10411 HICKORY RIDGE RD APT B
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City | COLUMBIA
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State | MD
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Zip | 21044-4631
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Country | US
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Telephone | 410-689-5876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | MT0016411
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | RSA-02344
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License Number State | MD
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