Individual
STACEY BOONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
618 MANZANO ST NE, ALBUQUERQUE, NM 87110-6302
(505) 925-4355
Mailing address
2301 YALE BLVD SE, ALBUQUERQUE, NM 87106-4228
(505) 925-4358
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NM
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
01/28/2015
Last updated
07/21/2022
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