MEDICARE: MRS. GERMAINE LOU BOONE RN, BSN, IBCLC

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	163WL0100X	Lactation Consultant (Registered Nurse)	37625	NE

General Provider Information

NPI Number	:	1336489178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GERMAINE LOU BOONE RN, BSN, IBCLC

Provider Business Mailing Address
First Line	:	8401 W DODGE RD STE 280
Second Line	:	CHILDREN'S PHYSICIANS
City	:	OMAHA
State	:	NE
Zip	:	68114-3493
Country	:	US
Telephone Number	:	402-955-6877
Fax Number	:

Provider Business Practice Location Address
First Line	:	9202 W DODGE RD STE 101
Second Line	:	CHILDREN'S PHYSICIANS - EMBASSY PARK
City	:	OMAHA
State	:	NE
Zip	:	68114-3318
Country	:	US
Telephone Number	:	402-955-7500
Fax Number	:	402-955-7524

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

Provider Enumeration Date	:	02/14/2013
Last Update Date	:	02/14/2013

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