Individual
NELLIE LUCILLE BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
500 E WEBSTER AVE, CHEWELAH, WA 99109-9523
(509) 935-8211
(509) 935-5257
Mailing address
500 E WEBSTER AVE, CHEWELAH, WA 99109-9523
(509) 935-8211
(509) 935-5257
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
TA10005278
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00450010
RAIL ROAD MEDICARE
WA
Enumeration date
10/09/2007
Last updated
06/03/2016
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