Individual
MARILEE GREEN BOMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Contact information
Practice address
551 E SOUTHAMPTON DR, COLUMBIA, MO 65201-4236
(573) 884-7733
(573) 882-6228
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
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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