Provider Demographics
NPI:1386460822
Name:BOONE, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:BOONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W FENDER RD
Mailing Address - Street 2:
Mailing Address - City:COLBERT
Mailing Address - State:WA
Mailing Address - Zip Code:99005-9605
Mailing Address - Country:US
Mailing Address - Phone:509-378-2492
Mailing Address - Fax:509-461-8677
Practice Address - Street 1:2304 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4170
Practice Address - Country:US
Practice Address - Phone:509-378-2492
Practice Address - Fax:509-461-8677
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHM60741994374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide