Individual
MR. PHANTHAVONG BOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN, CRNA
Contact information
Practice address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 239-7000
Mailing address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 239-7000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001186892
VA
163W00000X
Registered Nurse
14-153121-072
KS
163W00000X
Registered Nurse
202201644RN
OR
367500000X
Certified Registered Nurse Anesthetist
Primary
24179395
VA
367500000X
Certified Registered Nurse Anesthetist
43-557812-072
KS
Other
Enumeration date
11/22/2005
Last updated
02/16/2022
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