Provider Demographics
NPI:1063731511
Name:BOONE, STEPHANIE EMMA (RN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:EMMA
Last Name:BOONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 457 BOX 219
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09033-0003
Mailing Address - Country:US
Mailing Address - Phone:09721-475-8428
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC BAVERIA
Practice Address - Street 2:CMR 411, BLDG 700, ROSE BARRACKS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:01149966-283-4719
Practice Address - Fax:01149966-283-4719
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN122528163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN