Individual
MRS. SHELLY S BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1025 MACHESTER AVE, WABASH, IN 46992-1496
(260) 563-7421
(260) 563-7725
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28144111A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000504327
BCBS
IN
05
—
200842600
—
IN
01
—
21358
PHP
IN
Enumeration date
08/03/2006
Last updated
10/17/2022
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