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Individual
MARILEE GREEN BOMAR
Active
Individual
MARILEE GREEN BOMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
128845
MO
364SG0600X
Gerontology Clinical Nurse Specialist
Primary
128845
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420750200
—
MO
Enumeration date
06/01/2006
Last updated
05/03/2019
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