Provider Demographics
NPI:1528303005
Name:BOONE, BONNIE BOSWELL (RN, IBCLC, RLC)
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:BOSWELL
Last Name:BOONE
Suffix:
Gender:F
Credentials:RN, IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S LAKE EMORY DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-7257
Mailing Address - Country:US
Mailing Address - Phone:864-472-4692
Mailing Address - Fax:
Practice Address - Street 1:1700 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1041
Practice Address - Country:US
Practice Address - Phone:864-573-5000
Practice Address - Fax:864-573-3399
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN