Individual
PHYLLIS DIANE BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3600 E FULTON, GRAND RAPIDS, MI 49546-1322
(616) 949-4971
Mailing address
PO BOX 3140, GRAND RAPIDS, MI 49501-3140
(616) 459-0898
(616) 459-6963
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704108827
MI
Other
Enumeration date
10/18/2011
Last updated
10/18/2011
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